THORACOSCOPY - PRESENT DIAGNOSTIC AND THERAPEUTIC INDICATIONS

Thoracoscopy is increasingly being used for diagnosis and treatment of pleuropulmonary disease. The recent revival was made possible by the tremendous advances in endoscopic technology. The main requirements fo r diagnostic purposes are rigid telescopes and forceps, and for interv entional thoracoscopy scissors, staplers and a video recorder. The pro cedure can be performed either under local or general anaesthesia, wit h or without double lumen intubation, after inducing an artificial pne umothorax. At the end of the procedure, a chest tube should always be inserted, even if only for a few minutes until the lung re-expands. Ma in diagnostic indications are pleural effusions, pneumothorax and diff use lung disease. Main therapeutic indications are pleurodesis by talc age in effusion and pneumothorax and a variety of diseases of the lung , the pleura and the mediastinum, where thoracotomy may be replaced by video-assisted thoracoscopy. The well-known indications of the past r emain a domain of pneumologists, whereas minimal invasive thoracotomy is the task of thoracic surgeons. For some indications no sharp line h as to be drawn, provided the facilities and skills are present, includ ing those for the management of complications.