A thoracoscopy is a minimally invasive procedure that lets a thoracic surgeon look inside the chest using a thin tube with a camera and light called a thoracoscope.
The camera is passed through a small incision in the chest wall to examine the pleura, the thin lining that covers the outside of the lung and the inside of the chest wall. The space between these layers is called the pleural space or pleural cavity, which contains a small amount of fluid.
A thoracoscopy may be diagnostic, therapeutic, or both:
Video-Assisted Thoracoscopic Surgery (VATS) is a surgical form of thoracoscopy performed by a thoracic surgeon, usually under general anaesthesia. You may also hear the term medical thoracoscopy. This is usually performed by a respiratory or pleural specialist using local anaesthesia and sedation.
A thoracoscopy is performed when doctors need to directly visualise the pleural space, obtain tissue samples, drain the space, or treat recurrent collections of pleural fluid around the lung.
It is commonly used when pleural collections continue to accumulate, and the cause remains unclear after scans and tests. This is sometimes described as a thoracoscopy pleural effusion assessment. It is especially useful when cancer, tuberculosis, chronic pleural infection, mesothelioma, or another pleural disease is suspected.
A thoracoscopy may be recommended for:
In selected cases, VATS can also be used to remove tumours, excise damaged lung tissue, remove blebs, and treat conditions such as emphysema.
In cancer care, a thoracoscopy may help confirm the diagnosis, support staging, relieve symptoms, or guide treatment such as chemotherapy, immunotherapy, targeted therapy, or radiation therapy. It does not cure most advanced cancers on its own, but can provide important information and improve breathing comfort.
You should see a thoracic surgeon when pleural fluid, pleural thickening, recurrent pneumothorax or unexplained chest symptoms need direct assessment.
A lung specialist review is important if you have breathlessness, chest pains, recurrent pleural effusions, brownish pleural fluids, an unexplained weight loss, fever, a persistent cough, or imaging showing pleural nodules or thickening. It is also important if the previous thoracentesis did not provide a clear diagnosis.
A thoracic surgeon may be needed when VATS is indicated. This procedure may include:
Deciding between thoracoscopy and VATS depends on which approach is best suited to the patient’s diagnosis, anatomy, fitness, and treatment goals. A medical thoracoscopy may be sufficient for a pleural inspection, biopsy, and talc pleurodesis in selected patients. VATS with a video monitor may be better when more extensive surgical treatment is needed.
Preparation for a thoracoscopy focuses on confirming the reason for the procedure and reducing the risks of bleeding, infection and anaesthesia.
Bring previous scan reports, test results and a medication list to your consultation. These will help your doctor decide whether a thoracoscopy is likely to give useful information, or whether another test would be safer.
During a thoracoscopy, a camera is placed through a small chest incision so the doctor can inspect the pleura, drain fluid and take biopsies if needed.
A thoracoscopy may take about 40 to 60 minutes for simpler medical procedure cases. Video-Assisted Thoracoscopy may take longer if surgery, decortication or treatment of leaks is needed. Both are safe procedures.
After a thoracoscopy, you are monitored while the sedation or anaesthesia wears off and while the lung and pleural space are checked.
The main benefit of a thoracoscopy is that it can provide diagnosis and treatment through small incisions.
A thoracoscopy allows direct visual inspection of the pleura. This can make tissue sampling more accurate than blind methods. It can also drain pleural collections and excess fluid, support pleurodesis, assess lung entrapment, and help guide further treatment.
Compared with traditional open chest surgery, a thoracoscopy usually causes less postoperative pain, only a small amount of bruising, and allows a quicker recovery. Cosmetic results improve because the scars are smaller. The unaffected side of the chest remains undisturbed.
The result depends on the underlying condition. A thoracoscopy can provide answers and symptom relief, but it may not remove the need for oncology treatment, antibiotics, long-term catheter care or follow-up imaging.
A thoracoscopy is a generally safe procedure, but possible complications include pain, bleeding, infection, air leak, pneumothorax and fluid recurrence.
Our surgeons and care team at Neumark Lung & Chest Surgery Centre will explain the side effects based on your diagnosis, age, lung function, other medical conditions and the planned medical procedure.
Recovery after a thoracoscopy usually takes days to weeks, depending on the type of procedure and the condition being treated.
Seek urgent medical review if you develop fever, worsening breathlessness, increasing chest pain, wound redness, swelling, pus, heavy bleeding, dizziness, blue lips, or sudden deterioration.
Neumark Lung & Chest Surgery Centre can help determine whether a thoracoscopy, medical thoracoscopy, VATS or another pleural procedure is the right next step.
Neumark specialises in minimally invasive thoracic surgery with a multidisciplinary approach led by Dr Harish Mithiran, senior consultant at Gleneagles and Mount Alvernia hospitals. For patients with pleural conditions, pneumothorax, pleural thickening, suspected mesothelioma, empyema or trapped lung, this means careful reviews before recommending a procedure.
If a thoracoscopy has been recommended or if you have an unexplained effusion around the lung, contact Neumark for a consultation.
A thoracoscopy is minimally invasive, but it is still a chest procedure. A medical thoracoscopy is usually less invasive than VATS. VATS is a surgical form of thoracoscopy and is usually done under general anaesthesia.
You should not feel pain during the procedure because local anaesthetic, sedation or general anaesthesia is used. Chest discomfort can occur afterwards, especially if a chest drain or talc pleurodesis is used. Pain relief is provided.
A thoracoscopy uses small cuts and a camera to look inside the chest. A thoracotomy is open chest surgery through a larger incision. A thoracotomy may be needed when the disease is too complex to treat safely through small incisions.
A simpler medical thoracoscopy may take about 40 to 60 minutes. VATS can take longer if a biopsy, pleurodesis, decortications, or other surgical treatments are needed.
Common side effects include chest soreness, tiredness, a mild fever after talc pleurodesis, and discomfort from a chest drain. Less common complications include bleeding, infection, pneumothorax, air leak or fluid recurrence.
A thoracoscopy can help prevent recurrent pleural fluid when talc pleurodesis is performed, and the lung can fully expand. It may not work as well if the lung is trapped or the underlying disease remains very active.
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