Let's learn simply about Thoracoscopy, an examination that involves inserting a camera into the chest.

Has your doctor told you to have a 'Thoracoscopy'? You may have felt a little scared when you heard the name. "What is this?" "Is it a big operation?" "Is it really difficult?" Many questions like this may have come to mind. But it's actually not as scary as you think. It's a very common, relatively safe, and very simple procedure. So today, let's talk about it in a very simple way, in a way that will eliminate all the questions and fears you may have about it.

Simply put, what is Thoracoscopy?

Imagine, the doctor suspects that there is something wrong inside your chest, that is, in the area where the lungs are. But neither an X-ray nor a CT scan has been able to identify exactly what it is. At a time like this, how nice would it be if you could go inside and take a look? That is what this procedure called Thoracoscopy is used for.

Simply put, this involves making a very small incision in the skin of the chest and inserting a small camera through it. This camera is called a thoracoscope . It is a thin tube about the size of a pencil. It has a camera and a light at the end. When this camera is inserted, the doctor can clearly see your lungs, the space around the lungs (which we medically call the pleural space ), the diaphragm, and everything inside, such as the chest wall, on a large TV screen (monitor).

This procedure is often performed as part of a surgical procedure called Video-Assisted Thoracoscopic Surgery (VATS) . This means that the surgeon does not look at your body, but rather looks at the images on that big TV screen, and performs the surgery very delicately, using small instruments. This is a very advanced technology.

Is this being done as a test or as a treatment?

The answer to this question is actually, "You can do both." It varies depending on the reason you're doing this.

• Diagnostic Thoracoscopy: Sometimes the doctor just wants to see what's going on inside. Or, they may want to take a very small piece of tissue from a suspicious area to examine. We call this a biopsy . It's like a detective going in and looking for evidence. This is sometimes called a Pleuroscopy .

• For treatment (Therapeutic Thoracoscopy): Sometimes, the exact cause of the problem is known. Then this procedure is used to treat that problem. That is, it is done as part of a surgery.

When is a thoracoscopy necessary?

There are several reasons why a doctor might recommend this procedure. The main ones are:

• Find information that could not be found in tests such as chest X-ray, CT scan, and ultrasound scan.
• Remove part of the inner layer of the chest wall (pleura).
• Remove damaged parts of the lungs (this is called `lung volume reduction surgery`).
• Remove air pockets in the lungs.
• If there is cancer in the lungs, remove the cancerous part (lung resection).
• Remove the excess fluid that has accumulated around the lungs and use medication to prevent the fluid from accumulating again (this is called `pleurodesis`).

This surgery may be necessary, especially for people with conditions such as lung cancer or mesothelioma (cancer of the lining of the lungs). It is also used to treat cancers of the thymus gland or esophagus in the chest.

What is the difference between Thoracoscopy and Thoracotomy?

You've probably heard the term thoracotomy . Although both are chest surgeries, there's a big difference between the two. Thoracoscopy is like "looking through a keyhole." Thoracotomy is like "opening a door."

Let's look at the difference between these two methods this way.

Sometimes, after starting a thoracoscopy, if the surgeon determines that the surgery cannot be safely completed through these small incisions, they may switch to a thoracotomy with a larger incision. This is done for your safety.

How do you prepare before surgery?

Although this is not a major surgery, it does require some preparation.

• Talk to your doctor: Tell your doctor about all the medications, vitamins, and herbal remedies you take. Especially if you are taking blood thinners (such as aspirin, clopidogrel, or warfarin ), ask if you need to stop taking them a few days before your surgery.
• Fasting: On the day of surgery, you will be advised not to eat or drink anything for several hours (usually 6-8 hours) before the procedure. This is to prevent stomach contents from going up into the windpipe during anesthesia.

How the surgery is performed step by step

On the day of your surgery, knowing what to expect in the operating room can help reduce your anxiety. The surgery can take anywhere from half an hour to several hours, depending on what is being done inside.

1. Anesthesia: First, you will be put under general anesthesia. This means that you will not feel anything during the surgery and will be completely asleep. The medication will be given through a small tube (IV cannula) placed in your arm.

2. Connecting to a ventilator: After you are asleep, a tube is placed through your throat into your windpipe and connected to a breathing machine (a `ventilator`). This machine will breathe for you until the surgery is over. You will not feel any of this.

3. Making small incisions: Next, the surgeon will make two or three small incisions, no more than half an inch wide, in your chest, between your ribs.

4. Inserting the camera and instruments: Through one incision, the camera (the `thoracoscope`) we talked about earlier is inserted. Through other incisions, the very fine, long instruments needed for the surgery are inserted.

5. Examination or treatment: Now the doctor looks at the TV screen and carefully examines the inside of the chest. If a biopsy is needed, it is taken, if there is a part to be removed, it is removed, or the necessary treatment is performed.

6. Removing equipment: After the work is done, the camera and all other equipment are taken out.

7. Chest Tube Insertion: Next, a plastic tube (`chest tube`) is inserted into the chest cavity through one of the incisions. This is done to remove any air or fluid that may have accumulated after the surgery. This will need to be left in place for one or two days.

8. Stitching the incisions: Finally, the small incisions made are closed with stitches.

9. Waking up from anesthesia: Now the anesthesiologist will slowly wake you up. When you can breathe on your own, the tube that was in your throat will be removed.

What to expect after surgery?

After the surgery is over, you will be transferred to the ward.

• Drowsiness: Due to the effects of the anesthetics, you will feel drowsy and lifeless for a while.
• Sore throat: Since the breathing tube was inserted, there may be a slight soreness in the throat and a change in voice for a day or two.
• Pain: You will feel some pain at the incision sites. You will be given painkillers to help with this.
• Chest Tube: The chest tube will stay in place for a day or two. You will need to stay in the hospital until it is removed.
• Chest X-ray: A chest X-ray will be done again to see if the lungs are working properly.
• Food: Your throat and mouth may feel numb at first. You will not be allowed to eat or drink until the numbness goes away.

You can usually resume your daily activities after about two weeks. It can take four to six weeks to fully recover.

Is there a risk in this?

As with any medical procedure, there is a small risk involved. However, it is a very safe procedure. The mortality rate is very low, at 0.3%. The potential complications are also very low.

Possible complications (Risks)

• To flow.
• Cuts or lung infections.
• Fever.
• Air accumulation near the incision or in the lung space.
• Collapsed lung.
• Fluid accumulation around the lungs.

If something like this happens, your doctor and the hospital staff are ready to treat it. So don't worry about it.

After you go home, what time should you see the doctor?

It is very important to seek medical advice immediately if you experience any discomfort after you go home from the hospital. If you experience any of the following symptoms, inform your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.

It is very important to pay attention to these characteristics.

Thoracoscopy, VATS, lung surgery, chest surgery, pleuroscopy, lung biopsy, chest surgery sinhala