Name of the Procedure:

Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis

Summary

Thoracoscopy with total pulmonary decortication is a minimally invasive surgical procedure that involves inspecting the chest cavity via a thoracoscope, removing fibrous tissue from the lung surface, and separating adherences within the pleural space to allow the lung to expand properly.

Purpose

This procedure addresses restrictive lung conditions caused by thick fibrous tissue on the lung surface (pleural peel) and abnormal adhesions (intrpleural pneumonolysis). It aims to improve lung function, reduce symptoms such as shortness of breath, and prevent further complications.

Indications

• Chronic empyema (infected fluid in the pleural space)
• Complicated parapneumonic effusion (fluid buildup due to pneumonia)
• Extensive pleural thickening after infections or inflammatory diseases
• Trapped lung syndrome

Preparation

• Patients may need to fast for a specified period before the procedure.
• Medications may need adjustment, particularly anticoagulants.
• Preoperative tests include chest X-rays, CT scans, blood tests, and pulmonary function tests.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incisions: Small incisions are made on the chest wall for inserting the thoracoscope and surgical instruments.
3. Inspection: The thoracic cavity is inspected via thoracoscope.
4. Decortication: Fibrous tissues covering the lung are removed.
5. Pneumonolysis: Adhesions within the pleural space are carefully separated.
6. Closure: Instruments are removed, and incisions are closed with sutures or staples.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity.

Setting

Performed in a hospital operating room.

Personnel

• Cardiothoracic surgeon
• Surgical nurse
• Anesthesiologist
• Operating room technician

Risks and Complications

• Bleeding
• Infection
• Residual air leaks
• Injury to lung tissue
• Postoperative pain
• Respiratory complications

Benefits

• Improved lung expansion and function
• Relief from symptoms like breathlessness
• Enhanced quality of life Benefits are typically realized within weeks to months after the procedure.

Recovery

• Hospital stay for approximately 5-7 days.
• Pain management with medications.
• Breathing exercises and possibly physical therapy.
• Follow-up appointments for monitoring and chest X-rays.
• Restrictions on heavy lifting and vigorous activities for several weeks.

Alternatives

• Conservative management with antibiotics and chest drainage.
• Video-assisted thoracoscopic surgery (VATS) without extensive decortication.
• Open surgical decortication for severe cases. Pros and cons vary based on patient health, severity of the condition, and individual response to treatment.

Patient Experience

• During the procedure, patients will be under general anesthesia and feel no pain.
• Postoperatively, patients may experience pain at incision sites, managed with pain relief measures.
• Shortness of breath usually diminishes as the lung gradually expands and heals.

Pain management, medication, and support from medical personnel ensure patient comfort throughout the recovery period.