Therapeutic thoracoscopy

Abstract

Thoracoscopy was originally devised for diagnostic purposes but has subsequently come to have several therapeutic applications as well. This report reviews our experience with 13 patients in whom thoracoscopy was used in a therapeutic capacity. In three patients intrapleural foreign bodies (segments of polyethylene catheters) were removed endoscopically. In two patients open postpneumonectomy empyema cavities were explored and debrided thoracoscopically. In the remaining eight patients thoracoscopy was used to facilitate chemical pleurodesis in the treatment of effusions or pneumothoraces, after resectable disease had first been ruled out. Our conclusions are as follows: (1) Thoracoscopy can serve therapeutic as well as diagnostic functions. (2) Excellent exposure can be obtained during general anesthesia by use of one-lung ventilation. (3) Thoracoscopy is a safe, simple, and effective means of removing intrapleural foreign bodies. (4) Thoracoscopy allows chemical pleurodesis to be applied selectively to patients who will not require future thoracotomy; i.e., those with proved incurable malignant disease or with recurrent pneumothoraces without gross abnormalities of the pulmonary parenchyma. (5) Chemical pleurodesis is facilitated by this technique, which assures uniform exposure of all pleural surfaces to the sclerosing agent. (6) Pleurodesis is less painful when the sclerosing agent is introduced during general anesthesia. (7) Thoracoscopy allows safe, complete, visually guided débridement of open postpneumonectomy empyema cavities.