Purpose
A thoracoscopy is performed so the surgeon can:
- diagnose or treat a problem in the chest
- determine how far the disease has spread in the chest
- biopsy or remove a mass within the lung
- biopsy the lining of the chest wall
- stop pleural fluid from building up in the chest
The procedure is performed using an instrument called a thoracoscope. It is like a narrow telescope through which the doctor can see inside the chest cavity. Having a surgical procedure done with a scope is less painful, has a shorter hospital stay and shorter recovery period than having surgery where the chest is opened.
Preparation
At least two weeks before surgery, do not smoke.
The night before surgery:
- Scrub your chest thoroughly from neck to waist and under your arms with soap.
- Do not eat or drink anything after midnight.
Procedure
In the operating room:
- An intravenous line (IV.) will be put into a vein in your hand or arm.
- You will be given medicine to make you sleep; thoracoscopy is done under general anesthesia.
- You will be turned on your side.
- Your heart will be monitored and you will receive oxygen so you can breathe easily.
While you are asleep, several small incisions (cuts) will be made. These 1/2inch to 3/4inch (1.2 to 1.9cm) cuts will be on the front, side, or back of the chest. The thoracoscope will be passed into the chest cavity, so the surgeon can see if any problems exist. If a tumor or mass is found, a small piece of tissue will be removed and sent to the pathology lab to be examined. The surgeon's visual examination and the results of the pathology report will determine if more procedures are needed. A thoracotomy (surgery to open the chest) may be performed, if needed.
You may have a tube inserted in your chest during surgery to help drain fluid and reexpand your lung(s). Usually, the tube is removed 1 to 2 days after surgery.
After the Procedure
- You will wake up in the recovery room where you will be monitored for 2 to 3 hours.
- You will be able to drink liquids the evening after surgery and resume a regular diet the next day.
- Your pain medication will be oral pain pills, intravenous medication, or a combination of both.
You will be able to get up and move around, with some help, the evening of surgery or the next morning.
Coughing and deep breathing is very important to keep your lungs expanded and clear out any mucus or phlegm. This helps prevent problems like pneumonia after surgery.
Your chest tube will be removed several days after surgery, when the amount of fluid drainage has decreased and there are no air leaks from the lung. Most patients are able to go home the day that the tube is removed or the following morning. Depending on what type of surgery is done, most patients stay in the hospital 2 - 4 days after a thoracoscopy.
Discharge Instructions
Your Breathing
Many people find that they are a bit short of breath after a chest operation, particularly with exercise or activity. This will improve as you recover.
Keep coughing! Most people have some extra mucus or phlegm after a chest operation, especially if you are a smoker. Coughing and deep breathing will help clear it out and prevent problems such as pneumonia. The phlegm will usually be clear, but itâ¬"s not unusual to have some streaks of blood for a few days. If you cough up a lot of blood, if the blood is bright red, or if the mucus is brown, greenish, or foul smelling, call your doctor. Holding a pillow or folded blanket against your chest may help relieve some of the pain or pressure that your feel when coughing.
Do not smoke at all after the surgery. Smoking cessation programs are available. Ask your doctor or nurse for more information.
Pain
You can expect to have some discomfort after your operation. You will be given a prescription for pain medication when you go home and we encourage you to use it. It is important to have adequate pain relief so you are able to cough and deep breathe effectively and get up and move around. You may also use or ibuprofen (Motrin, Advil) to supplement the prescription pain medication.
As you heal, you can expect the pain to gradually subside and eventually disappear. After a week or two, you will probably be able to stop the prescription pain medication. You may also notice some numbness or a burning-type sensation in the area of your incisions. This is also normal and will gradually disappear.
Activity
You are encouraged to be as active as you feel comfortable being. You may feel fatigued and tire easily, but as you recover you will regain your strength and stamina.
You may do as much walking as you feel comfortable doing. It the weather permits, you may take a walk outside. Your breathing may be a bit more difficult it if is bitter cold or very hot and humid, and remember: as far as you walk, you'll have to walk that far to get back home! You may go up and down stairs if you need to; be careful not to lose your balance. You should avoid using an exercise bike or a treadmill until your incisions are healed.
Gently exercise your arm and shoulder on the side of your operation. You may feel a tightness or pulling in the area of the incision, but gentle stretching will not tear anything apart. Avoid strenuous exercise or heavy lifting until you are completely healed (three to six weeks).
You may ride in a car, but you shouldn't drive for several weeks. When you are no longer taking prescription pain medication and movement of your arms and chest is not limited by pain, it is safe to drive.
Care of Your Incisions
When you go home, your small incisions will generally not need any dressing or bandage and can be left open to air. There will usually be a bandage over the incision where your chest tube was removed. There may be some drainage from the chest tube incision for a few days after the tube is removed. The fluid draining is usually yellow or pink and will usually stop in a few days. Keep a dry gauze bandage over these wounds until the drainage stops. If the dressings become saturated, they can simply be changed. Once the drainage stops, a scab will form and the dressings are no longer needed.
You may shower when you go home. Your incisions may be gently washed with soap and water. If you have metal clips in your incisions, it's okay to get them wet (they're stainless steel and will not rust). The clips will be removed at your follow-up visit a week or two after discharge. If you have tape strips on your incisions, these may be gotten wet also; they will peel off on they're own, usually in a week or two.
Call your doctor if redness, swelling or tenderness develops in the area of your incisions, drainage from the incisions looks like pus.
Follow-up
After you are discharged from the hospital, call your doctor's office for a follow-up visit. Your doctor will usually want to see you 10-14 days after discharge. Your doctor may want you to have a chest X-ray the day before or the day of your follow-up visit. This X-ray can be compared to the one you had in the hospital to check how your lungs are recovering from surgery.
If you have any problems or concerns, call our office at (518) 926-5864. To schedule appointments or for routine questions, please try to call during our regular office hours, 8:30 AM to 5:00 PM, Monday through Friday. If you have a serious problem or an emergency, don't hesitate to call, someone is always available.
