Name of the Procedure:

Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy

Summary

Thoracoscopy with mediastinal and regional lymphadenectomy is a minimally invasive surgical procedure used to diagnose and treat conditions within the chest cavity. It involves inserting a thin, flexible tube with a camera (a thoracoscope) and other instruments into the chest to remove lymph nodes from the mediastinum and surrounding areas for examination.

Purpose

This procedure is primarily used to diagnose and stage cancers of the thoracic cavity, such as lung cancer, by examining and removing lymph nodes. Removing these lymph nodes helps in determining the extent or spread of cancer, which is crucial for planning further treatment. It can also be used to treat infections, inflammations, or other thoracic diseases involving lymph nodes.

Indications

• Suspected or confirmed thoracic cancers like lung cancer
• Abnormal chest imaging findings (such as enlarged lymph nodes)
• Persistent chest infections not responding to treatment
• Evaluation and staging of known cancer to plan treatment
• Unexplained chest pain or symptoms related to lymph nodes

Preparation

• Patients are usually required to fast 8-12 hours before the procedure.
• Medication adjustments may be necessary, particularly blood thinners.
• Pre-procedure diagnostic tests may include chest X-rays, CT scans, blood tests, and pulmonary function tests.
• The patient will receive specific instructions from their healthcare provider regarding any preoperative preparations.

Procedure Description

1. The patient is administered general anesthesia for comfort and to prevent pain.
2. A small incision is made in the chest wall, and a thoracoscope is inserted.
3. Additional small incisions may be made to provide access for surgical instruments.
4. The thoracoscope transmits images to a monitor, allowing the surgeon to visualize the area.
5. The surgeon carefully dissects and removes the mediastinal and regional lymph nodes.
6. The lymph nodes are sent to a laboratory for pathological examination.
7. The incisions are sutured closed, and sterile dressings are applied.

Tools and Equipment:

• Thoracoscope
• Surgical instruments for dissection and removal of lymph nodes

Anesthesia:

• General anesthesia

Duration

The procedure usually takes between 1 to 3 hours, depending on the complexity and the number of lymph nodes removed.

Setting

Thoracoscopy with lymphadenectomy is typically performed in a hospital operating room.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Bleeding
• Infection
• Injury to nearby organs or structures
• Pneumothorax (collapsed lung)
• Prolonged air leak
• Reaction to anesthesia
• Pain at the incision sites

Management involves immediate medical intervention to address any complications and post-operative care to monitor the patient's recovery.

Benefits

• Accurate diagnosis and staging of thoracic conditions, particularly cancer
• Minimally invasive with smaller incisions and quicker recovery
• Provides critical information for treatment planning
• May alleviate symptoms caused by enlarged or infected lymph nodes

Recovery

• Post-procedure, the patient may need to stay in the hospital for observation.
• Pain management includes prescribed pain relievers.
• Patients may have a chest tube in place temporarily to remove air or fluid.
• Normal activities can usually be resumed in 1-2 weeks, with full recovery within several weeks.
• Follow-up appointments are necessary to monitor healing and review pathology results.

Alternatives

• Traditional open thoracotomy, which involves larger incisions and longer recovery
• Non-surgical biopsy or imaging techniques, which may be less definitive
• Needle biopsy, although less invasive, can be less accurate for staging

Patient Experience

Patients may experience postoperative pain and discomfort, particularly at incision sites. Pain is typically managed with medications. They may feel some shortness of breath or fatigue initially, but these symptoms often improve as recovery progresses. The healthcare team will provide measures to ensure comfort and address any pain or concerns throughout the recovery period.