32656 Thoracoscopy, surgical; with parietal pleurectomy

Name of the Procedure:

Thoracoscopy, surgical; with parietal pleurectomy
Common Names: Video-Assisted Thoracoscopic Surgery (VATS) with Parietal Pleurectomy

Summary

A thoracoscopy is a minimally invasive surgical procedure that allows doctors to view the chest cavity using a small camera. The parietal pleurectomy involves removing the parietal pleura, a membrane lining the chest wall, to treat various pleural diseases.

Purpose

Medical Condition Addressed

• Pleural effusion (excess fluid in the pleural space)
• Mesothelioma
• Recurrent pneumothorax (collapsed lung)
• Pleural infections

Goals/Outcomes

• Relieve symptoms such as chest pain and shortness of breath
• Prevent recurrence of pleural conditions
• Improve lung function and patient quality of life

Indications

• Persistent pleural effusions not responding to conservative treatment
• Recurrent episodes of pneumothorax
• Diagnosed or suspected pleural mesothelioma
• Chronic pleural infections

Preparation

Pre-Procedure Instructions

• Fasting for at least 6 hours before the procedure
• Discontinuation of certain medications like blood thinners, as per doctor’s advice
• Pre-operative testing including blood work, chest X-ray, or CT scan

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incisions: Small incisions are made in the chest wall.
3. Insertion of Thoracoscope: A camera called a thoracoscope is inserted through one of the incisions to provide visual guidance.
4. Surgical Removal: Instruments are inserted through other incisions to perform the pleurectomy, removing the diseased parietal pleura.
5. Drain Placement: A chest drain may be placed to remove any excess air, fluid, or blood.
6. Closure: The incisions are closed with sutures or staples.

Tools and Equipment

• Thoracoscope (camera)
• Surgical instruments (scissors, forceps)
• Chest drain

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital operating room.

Personnel

• Surgeons specializing in thoracic surgery
• Anesthesiologists
• Surgical nurses and technicians

Risks and Complications

Common Risks

• Infection
• Bleeding
• Pain at incision sites

Rare Risks

• Pneumonia
• Lung injury
• Reaction to anesthesia

Management

• Antibiotics for infections
• Drainage and observation for other complications

Benefits

• Symptom relief from chest discomfort and breathing difficulties
• Prevention of pleural disease recurrence
• Potential for improved lung function and quality of life

Recovery

Post-Procedure Care

• Monitoring in a recovery room for a few hours
• Pain management with prescribed medications
• Instructions for wound care at home

Expected Recovery Time

• Hospital stay: 1-3 days
• Full recovery: 2-4 weeks

Restrictions

• Avoid heavy lifting for several weeks
• Follow-up appointments for chest X-rays and doctor evaluations

Alternatives

Alternatives Available

• Thoracentesis (fluid drainage)
• Pleurodesis (pleural space obliteration)
• Open surgery (thoracotomy)

Pros and Cons

• Thoracentesis: Less invasive but temporary relief
• Pleurodesis: Effective but can cause significant pain and discomfort
• Open Surgery: More invasive with longer recovery but potentially more thorough

Patient Experience

During Procedure

• Patient will be under general anesthesia and unconscious.

After Procedure

• Pain and discomfort, manageable with medications
• Soreness around incision sites
• Possible chest drain presence for a few days

Pain Management

• Prescription pain relief medications
• Use of ice packs and avoiding strenuous activities as advised