Thoracoscopy and pleural biopsy

Thoracoscopy is a test to look at the space between your lung and chest wall. This is the pleural cavity. You might have a thoracoscopy to check for signs of cancer such as mesothelioma.

It is a small operation. The doctor uses a flexible tube with a light and video camera attached. This is called a thoracoscope. They use it to take samples (biopsies) from the tissues that cover your lung (pleura).

Why you might have it

You have a thoracoscopy to look inside your chest to see possible areas of cancer.

Doctors use a thoracoscopy to help diagnose cancers such as lung cancer and mesothelioma. They might also do a thoracoscopy to:

• remove fluid and air from the space between the lung and chest wall
• take samples of tissue (biopsies) that cover your lung (pleura)
• put in a chest drain
• treat fluid on the lung (pleurodesis)

Preparing for a thoracoscopy

The hospital will give you instructions about preparing for the test and what to bring on the day.

Let the hospital department know if you're taking medicines that change how your blood clots. This includes:

• aspirin
• clopidogrel
• arthritis medicines
• warfarin or heparin
• apixaban or rivaroxaban

You might need to stop taking this type of medicine a number of days before your thoracoscopy. Your doctor or nurse will tell you when you should stop. They will also tell you if you need to stop taking other medicines. 

Before an anaesthetic

You have the operation under a general anaesthetic which means you are asleep. Or you have a local anaesthetic and a medicine to make you drowsy (sedation).

Before a general anaesthetic you need to stop eating for 6 hours beforehand and stop drinking about 2 hours before the test.

Tell your doctor or nurse if not eating might be a problem for you, for example, if you have diabetes.

What happens

When you arrive a nurse will check your weight, blood pressure, temperature, heart and breathing rate. The nurse will also ask you to:

• change into a hospital gown
• take off any jewellery (except for a wedding ring)
• take off makeup, including nail varnish
• remove contact lenses and false teeth

You can usually keep false teeth in until you get to the anaesthetic room. They may also ask you to wear special stockings on your legs. These help to prevent blood clots forming. 

You meet the doctor who will explain the procedure and asks you to sign a consent form. This is a good time to ask any questions you may have.

If you are having a general anaesthetic you will also meet the anaesthetist. They will look after you while you are sleep.

You might have a medicine to make you feel drowsy before you go to the operating theatre. This is called a sedative. You need to stay in bed after you have had this.

Your nurse takes you to the operating theatre when it's time for your test.

During the test

The anaesthetist puts a small tube into a vein in the back of your hand (cannula). Then they give you the anaesthetic through the cannula.

Once you're asleep, your doctor makes a small cut (incision) in the inside of your chest between 2 ribs. Then they put a flexible tube with a light and video camera attached (thoracoscope) into the hole. They might use a CT scan or ultrasound scan to position the thoracoscope accurately.

A camera at the end of the tube connects to a large screen. The doctor can see pictures of the inside of your chest on the screen. They can examine the area between your lungs.

Using forceps, the doctor takes a small sample (biopsy) of the tissues that cover the lungs (the pleura). They usually take a sample from the outer layer of the pleura. This is called the parietal layer.

They send the sample to a laboratory to see if there are any cancer cells.

The doctor leaves the chest tube in place. This is so any remaining fluid and air can drain from your chest. They stitch the tube so it doesn’t come out.

After the test

You might be able to go home several hours later, after they remove the chest tube. But some people need to stay in hospital. Your doctor will tell you what to expect.

If you have sedation or a general anaesthetic you’ll need someone with you. This is so they can take you home and stay with you overnight. For 24 hours after having a general anaesthetic you shouldn’t:

• drive
• drink alcohol
• operate heavy machinery
• sign any legally binding documents

Possible risks

A thoracoscopy is a very safe procedure. Your nurse will tell you who to contact if you have any problems after your test. Your doctors will make sure the benefits of having a thoracoscopy outweigh any possible risks.

Some of the possible risks include:

Bleeding

There is a risk of bleeding. Contact your doctor if your wound starts to bleed, you have chest pain or if your breathing gets worse.

Infection

Contact your doctor if your wound is red and feels hot. Let them know if you have a high temperature or feel feverish. You might need antibiotics to treat an infection.

Collapsed lung (pneumothorax)

Air can collect in the space around the lung and make it collapse. But this is rare. Contact a doctor straight away if you have shortness of breath or chest pain. Your doctor might need to put a tube into the lung for a few days until the lung expands again.

Pain

You may feel sore and some pain at the site for a few days after the test. You’ll be given painkillers to help with this. Contact your GP if you continue to get chest pain.

Getting your results

You should get your results within 1 or 2 weeks. The doctor may be able to let you know if they have seen any abnormal areas that have been sent to the laboratory.

Waiting for results can make you anxious. Ask your doctor or nurse how long it will take to get them.

Contact the doctor who arranged the test if you haven’t heard anything after a couple of weeks.

You might have contact details for a specialist nurse who you can contact for information if you need to. It can help to talk to a close friend or relative about how you feel.