Name of the Procedure:

Thoracoscopy, surgical; with pleurodesis (e.g., mechanical or chemical) Common Names: Thoracoscopic Pleurodesis, VATS Pleurodesis (Video-Assisted Thoracoscopic Surgery pleurodesis)

Summary

Thoracoscopy with pleurodesis is a minimally invasive surgical procedure that involves examining the pleural space (the area between the lungs and the chest wall) with a thoracoscope (a small camera) and then inducing pleurodesis, a process that causes the pleural layers to stick together. This can be achieved mechanically by irritating the pleura or chemically by introducing a sclerosing agent.

Purpose

This procedure is typically performed to manage recurrent pleural effusions (excess fluid in the pleural space) or pneumothorax (collapsed lung). The goal is to eliminate the pleural space to prevent the recurrence of fluid accumulation or lung collapse.

Indications

• Recurrent pleural effusions (commonly due to cancer, heart failure, or infections)
• Recurrent pneumothorax (collapsed lung)
• Persistent lung air leaks

Preparation

• Fasting for a certain period (usually from midnight before the procedure).
• Medication adjustments, especially blood thinners.
• Preoperative tests such as chest X-rays, CT scans, ECG, and blood tests.

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the chest wall.
3. A thoracoscope is inserted through an incision to visualize the pleural space.
4. Any excess fluid is drained.
5. The pleurodesis is performed using either mechanical abrasion of the pleura or the introduction of a chemical agent.
6. The instruments are removed, and the incisions are closed.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital operating room.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Possible respiratory therapist

Risks and Complications

• Infection
• Bleeding
• Pain
• Respiratory difficulties
• Re-expansion pulmonary edema
• Rarely, allergic reactions to the chemical agent used in pleurodesis

Benefits

• Significant reduction in the recurrence of pleural effusions or pneumothorax.
• Improvement in respiratory function and symptoms.
• Enhanced quality of life.

Recovery

• Patients may need to stay in the hospital for a few days.
• Chest tubes may be placed post-operatively to drain any remaining fluid or air until healing occurs.
• Pain management with medications.
• Follow-up appointments to monitor recovery and ensure pleurodesis efficacy.
• Gradual return to normal activities usually within 2 to 4 weeks.

Alternatives

• Thoracentesis (needle aspiration of pleural fluid)
• Pleural catheter placement
• Conservative management (medication therapy)
• Open thoracotomy (more invasive surgery)

Pros of alternatives:

• Less invasive procedures have shorter recovery times.

Cons of alternatives:

• Higher chance of recurrent fluid or air accumulation.
• May not be as effective in severe cases.

Patient Experience

• During: Patient will be under general anesthesia, so no awareness or pain during the procedure.
• After: Mild to moderate pain managed with medication, discomfort from chest tubes, gradual improvement in breathing and overall comfort as recovery progresses.