OUTPATIENT THORACOSCOPY - A CASE-REPORT AND DISCUSSION

Thoracoscopy has long been recognized as having significant diagnostic and therapeutic value. We present a new, less invasive method of obta ining good biopsy specimens of pleural based lesions using a single in cision and on an outpatient basis. JW, who has a history of Hodgkin's Lymphoma, presents with a suspicious pleural mass adjacent to the AP w indow and not amenable to percutaneous biopsy. She was admitted to the ambulatory surgery unit and underwent video thoracoscopic biopsy of t he lesion through a single 12 mm incision. Surgery time was 25 minutes , and frozen section revealed Hodgkin's lymphoma. No chest tube was in serted, and post-op chest film revealed a small pneumothorax that reso lved in 4 hours. The patient was ready for discharge at that time. The technique we used involved placing a standard 10 mm trocar and scope in the midaxillary line with the patient in the lateral decubitus posi tion. Once the scope is in, the trocar is pulled back so that a medias tinal biopsy forcep can be placed alongside the camera through the sam e hole. The biopsy is taken, and irrigation and cautery instruments ca n then also be placed and used in a similar manner. Before removing th e camera, a prolene pursestring suture is placed around the incision. While the anesthesiologist inflates the lung, the camera is slowly rem oved, watching all lobes inflate. The pursestring is then tied and the patient awakened. We have performed seven of the above procedures thu s far with good results. We feel the following are essential in patien t selection for outpatient thoracoscopy: 1) The lesion to be biopsied is pleural based. If the lung parenchyma is violated, then chest tube should be left in postoperatively; 2) The patient must not have an eff usion, as this will impair the ability of the lower lobe to re-expand; 3) The patient exhibits good pulmonary toilet. In conclusion, we feel that outpatient thoracoscopic biopsy of pleural based lesions not ame nable to percutaneous needle biopsy can be performed safely in selecte d patients.