DIAGNOSTIC AND THERAPEUTIC THORACOSCOPY - TECHNIQUES AND INDICATIONS IN PULMONARY MEDICINE

Recently thoracoscopy has been used with increasing frequency for the diagnosis and treatment of pleuropulmonary diseases. Methods: The main requirements for thoracoscopy are rigid telescopes, forceps, scissors , stapler and a video recorder. The procedure can be performed either under general anaesthesia with or without double lumen intubation or u nder neuroleptanalgesia after inducing an artificial pneumothorax. At the end of the procedure a chest tube should always be inserted even i f it is only for a few minutes until the lung re-expands after diagnos tic thoracoscopy. Complications are exceptional and mortality is less than 0.017%. Indications and Results: Thoracoscopy is useful for diagn osis of a number of lung diseases. For pleural effusion, the sensitivi ty of thoracoscopy is 92-97% and its specificity is 99%. This is much better than needle pleural biopsy and/or fluid cytology. In malignant mesothelioma, thoracoscopy allows accurate staging. Similarly in spont aneous pneumothorax, classification based on the endoscopic aspects of the lung according to the classification of Vanderschueren allows a b etter selection of therapeutic alternatives. For diffuse pulmonary dis eases, thoracoscopic lung biopsy has a sensitivity ranging from 60-98% depending on whether the underlying disease is sarcoidosis, idiopathi c fibrosis, collagenous diseases or other rare diseases. Interventiona l thoracoscopy is a rapidly expanding domain. In this review the most widespread techniques are summarized. Thoracoscopic pleurodesis is per formed for pleural effusion. It can be achieved by talc poudrage but o ther methods are available. For spontaneous pneumothorax, pleurodesis must be associated with treatment of the causal lesions. The other the rapeutic procedures described here are sympathectomy for palmar hyperh idrosis, pulmonary biopsy using an endo-GIA stapler and pericardial bi opsy.