EQUIPMENT FOR THORACOSCOPY

The combining of miniaturized video technology with thoracoscopy now a llows surgeons to perform a variety of thoracic procedures percutaneou sly. Both rigid and flexible video thoracoscopes are available. The ri gid endoscope has a camera located proximally at the eyepiece and is c apable of excellent resolution. However, visualization of the entire p leural cavity is difficult because of the rigid chest wall. Placing th e video camera at the distal end of a flexible thoracoscope, as in the electronic video thoracoscope (EVE-L; Fujinon, Wayne, NJ), yields bet ter visualization of these relatively inaccessible areas. However, dis advantages of the flexible thoracoscope include increased expense and complexity, reduced resolution as compared to rigid systems, and the n eed for a strobed light source, thus making video-assisted surgery mor e difficult. Thoracoscopic wedge excisions of the lung are now possibl e because of the adaptation of gastrointestinal staplers for percutane ous use. The initial design consisted of a reloadable 30-mm disposable stapler. Newer models, however, have a longer staple line and some ar e reusable. Future refinements may allow the head of the instrument to articulate, thus permitting it to be applied to the lung at various a ngles. Thoracoscopic ports that provide an air-tight seal are availabl e but are not essential; therefore, standard thoracotomy instruments c an be utilized through small open incisions. Specialized disposable th oracoscopic instruments are also available, including scissors, dissec tors, and fan retractors. It is hoped that the future will bring impro ved optics, better staplers, and refined percutaneous instrumentation.