The Egyptian Journal of Bronchology
JUNE 2010 |
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REVIEW ARTICLE
MEDICAL THORACOSCOPY: UPDATE, INDICATIONS, METHODOLOGY, AND OUTCOMES
By
Emad Ibrahim,1 Marc Noppen,2
1Alexandria Faculty of Medicine, Alexandria, Egypt, 2Interventional Endoscopy Clinic, Respiratory Division, University Hospital AZ-VUB, Brussels, Belgium
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Background:
Thoracoscopy is the insertion of an endoscope through the chest wall to enable a physician to visualize the inside of the chest cavity. It is the window for the pleural space and intrathoracic structures. The technique was first introduced in 1866 by S Gordon, who observed the thoracic cavity with a binocular instrument in a case of purulent effusion, and refined by Hans Jacobaeus, a Swedish internist who used a cystoscope to evaluate the pleural space. Thoracoscopy continued to be performed by chest physicians throughout continental Europe, primarily for diagnosis and treatment of pleural disorders. It has recently become increasingly popular in the UK and US, and since 1990, more than 300 articles have been published in the English-speaking literature.
Objectives:
To review the history, indications, methodology and outcomes of medical thoracoscopy.
Methods:
Literature review.
Results:
The medical thoracoscopic approach to a variety of diagnostic and therapeutic problems has been shown to be safe and cost effective as compared with more conventional approaches. It is an easy short stay procedure with simple reusable instrumentation. Procedure-related mortality is rare (0.24%, which is comparable to that of bronchoscopic biopsy) in experienced hands. Potential adverse events include bleeding, persistent pneumothorax, intercostal nerve and vessel injury, cardiac arrythmias, complications related to anesthesia, respiratory failure, wound infections, and malignant seeding of the chest wall. Potential advantages of thoracoscopy over more conventional techniques include certainty of representative tissue for diagnosis, reduced requirements for postoperative analgesia, shorter hospital stays, and a shorter duration of chest tube drainage.
Conclusions:
Due to its relative simplicity, ease of use, low costs, safety, effectiveness, and high availability, medical thoracoscopy has become increasingly popular among pulmonologists. In many indications thoracoscopy compares favourably with thoracic surgery techniques.
Keywords: Medical Thoracoscopy, Pleural diseases, Diagnostic Therapeutic.
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