Pleuroscopy - Exploring New Horizons in Lung Health

Introduction

The other name for pleuroscopy is medical thoracoscopy. It is a procedure in which the medical professional uses a fluoroscope to visualize the space between the chest and lungs. It is a thin, delicate, and adjustable tube with a camera. It can also record videos when the medical professional performs the surgery. Also, the attached light provides a clear vision of the operated site. This is hence called video-assisted thoracic surgery (VATS). It is an invasive procedure involving the ribs and chest.

What Are the Uses of Pleuroscopy?

The various indications of pleuroscopy are as follows:

• Diagnosis - The patient suspected of lung disease is diagnosed using pleuroscopy. The abnormal chest area is observed using pleuroscopy. Pleuroscopy is performed using X-rays and computed tomography (CT) scans.

• Biopsy - The enlarged lymph nodes and tissue in the lung lobes are removed for biopsy samples using pleuroscopy to diagnose mesothelioma (cancer developing in the lining covering the outer surface of the body organ). It also removes tissue from the esophagus and thymus gland for biopsy.

• Lung Tumors - A parietal or complete lobe is removed depending on the tumor size. Hence pleuroscopy can also be used for treatment procedures. This surgical procedure is called a lobectomy.

• Pleurodesis - The fluid causing a lung infection is removed using pleuroscopy. This makes the individual breathe easily without fluid obstruction. The drugs can also be delivered to the affected area to prevent fluid accumulation in the chest.

• Pleural Effusion - The fluid in the pleural space is drained with pleuroscopy. A small sample of fluid is sent to the laboratory for this purpose. It is used to diagnose the presence of cancer cells due to malignant pleural effusion.

How to Prepare for a Pleuroscopy?

The patient should follow the below instructions before pleuroscopy:

• Update the medical reports like previous surgeries, herbal or vitamin supplements, and medications to the surgeon before pleuroscopy.

• Before pleuroscopy, inform the surgeon about the history of allergy to anesthesia or latex gloves.

• Individuals should stop taking three to four doses of blood thinners, diuretics, and insulin before pleuroscopy on the advice of a medical professional.

• The individual should eat or drink water eight to nine hours before pleuroscopy. Avoid eating or drinking after that.

• Individuals with rare conditions like sleep apnea should give prior information to the medical professional.

• Avoid smoking tobacco before pleuroscopy.

• Remove jewels, glasses, and dentures, and wear a hospital gown before pleuroscopy.

• The temperature, pulse rate, and blood pressure should be ideal before pleuroscopy.

• Patients with severe diabetes should control their blood sugar levels before pleuroscopy.

How Is Pleuroscopy Performed?

The step-by-step pleuroscopy procedure is as follows;

• The medication is delivered through an intravenous route before pleuroscopy.

• The patient should lie down facing the doctor.

• During pleuroscopy, the patient's heartbeat is monitored continuously using an electrocardiogram (ECG) machine.

• A pulse oximeter is attached during pleuroscopy. If there are any changes in the oxygen level, then supplemental oxygen is provided.

• The incision is made in the desired site of the chest.

• The ribs are kept apart during the insertion of the pleuroscope.

• A rigid type of pleuroscope is used to treat pleural effusion.

• A vacuum is used as a suction to drain the debris during pleuroscopy.

• After pleuroscopy, a chest tube is placed to drain the air or blood, or fluid.

• A suture is placed after the pleuroscopy procedure.

What Are the Instructions to Follow After the Pleuroscopy?

• A chest X-ray is taken after a pleuroscopy to determine the lung condition.

• After pleuroscopy, avoid water and food for two hours.

• Do not smoke after pleuroscopy as it induces nausea and infections.

• If there is vomiting with blood streaks after pleuroscopy, consult the doctor immediately.

• Continue regular medications like anticoagulants and anti-diabetic drugs after pleuroscopy.

• Caretakers must accompany the patient while walking after a pleuroscopy.

• Acetaminophen is prescribed to reduce pain after pleuroscopy. Patients should not intake non-steroidal anti-inflammatory drugs (NSAIDs) like Aspirin after pleuroscopy.

• Avoid lifting heavy weights or cycling, or swimming after pleuroscopy.

• Avoid water near the incised area during bathing. Prevent moisture entrapment by covering the area with a bandage or dressing.

• Keep the incised area clean after pleuroscopy until healing.

What Are the Complications Associated With Pleuroscopy?

There are few contraindications associated with pleuroscopy. They are as follows;

• Medical Conditions - It increases the risk in patients with cystic fibrosis (an inherited disorder causing damage to the lung and digestive system), chronic obstructive pulmonary disorders or COPD (breathing problems due to a restricted airflow), and heart attacks (obstruction in the blood flow to the heart muscles).

• Pain - Some patients have pain in the incised site after pleuroscopy. It makes them feel uncomfortable.

• Injury - During the insertion of a pleuroscope, the pleura or lungs may get injured. It is a rare scenario because pleuroscopy is a safe procedure.

• Infection - Patients with pneumonia are already prone to respiratory infections. Using unsterile instruments during pleuroscopy can lead to infection.

• Bleeding - Patients with hemophilia can bleed excessively after pleuroscopy. However, compression procedures are used by a medical professional to control bleeding.

• Lung Collapse - In case of air entrapment during the pleuroscopy, the lung can collapse, and the patient is ventilated.

• Asbestosis - Pleuroscope can damage the lungs in patients with asbestosis (a lung disorder due to persistent exposure to asbestos).

Conclusion

The pleuroscopy is contraindicated in patients with a history of stroke and a pacemaker. It should not be used in patients recently undergoing radiation and bypass surgery. The patient is usually discharged if a pleuroscopy is done for diagnostic purposes. The patient is admitted to the hospital if it is used for surgical procedures. The time for pleuroscopy procedure takes around one to two hours. The cost of a pleuroscopy procedure can be covered by medical insurance. The patient should go for a follow-up after two weeks of pleuroscopy. The biopsy report is interpreted after a few weeks of pleuroscopy. Chest X-rays are taken during follow-ups also to check the incised site in pleuroscopy. The wound heals faster after pleuroscopy. Also, the prognosis of conditions like pleural effusion is much more effective than other surgical procedures.