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Thoracoscopy is a procedure that uses a fiberoptic endoscope inserted through small incisions to visualize the contents of the chest cavity. It involves a general anesthetic, and is a less invasive than thoracotomy (surgically opening the chest) as a means to take sample from within the thorax.
Thoracoscopy is principally used to investigate lesions within the chest and carry out certain surgical procedures; these include harvesting tissue for histology, removing lung tumors, and pericardiectomy (making a window in the membrane around the heart).
Thoracoscopy requires special equipment and is therefore undertaken at specialist referral centers. However, the advantages of thoracoscopy over thoracotomy include a shorter recovery time, lower morbidity, and less discomfort for the patient.
The patient will already have had a diagnostic workup such as blood tests, radiography, or an MRI/CT scan to diagnose and localize the problem within the chest. The patient is first stabilized and then give a general anesthetic.
The dog is positioned lying on their back, or their side, depending on the procedure to be performed. There, small stab incisions are made through the prepped skin over the chest. These allow for the passage of the endoscope and instruments to manipulate tissue.
Because the ribs provide rigid structure, it is not necessary to inflate the chest with carbon dioxide. The ports made for the instruments allows air to pass into the chest, which improves visualization of the organs. However, this also means the lungs collapse so the anesthetist must use positive pressure ventilation to breath for the dog.
The clinician thoroughly inspects the chest cavity via the endoscope, and manipulates the instruments to perform whatever procedure is required. A chest drain is placed, which then allows for the continued draining of air from the chest on recovery, and the lungs to inflate.
Once awake, pain relief is essential. The patient is also closely monitored for complications which include lung collapse, hypothermia, poor circulation, hemorrhage, and sepsis.
Thoracoscopy offers the exciting possibility of a minimally invasive procedure that may replace the need for open chest surgery. This is less traumatic for the patient and improves survival rates.
Thoracoscopy does require special equipment and its availability is therefore limited, however, it is rising in popularity as more surgeons realize its potential.
Alternatives such as opening the chest between two ribs or cracking open the sternum are associated with significant pain and discomfort. Whilst this can be managed with rigorous pain relief, it remains a major undertaking.
Post-thoracoscopy the patient should be placed in intensive care. They are closely monitored for signs of collapsed lungs (due to air leakage into the chest), hemorrhage, discomfort, and low body temperature. Painkillers may be administered intravenously as a constant rate infusion, in order to keep the patient comfortable.
The dog will have the small incisions in the skin, which are sutured. The sutures are removed after 10 to 14 days. An improvement in the patient's underlying condition will depend on identifying and treating the cause, or the success of the procedure performed via thoracoscopy.
This is minimally invasive surgery, but it doesn't come with a minimal price tag to match. Thoracoscopy largely occurs in specialist centers, where the cost of a consultation is around $200. The actual procedure is likely to range from $2,000 to $5,000.
Thoracoscopy is minimally invasive surgery but is still in its infancy in general use. The advantages include less pain and discomfort for the patient, and faster recovery times than for an equivalent procedure performed via an open chest.
However, not all procedures are amenable to 'keyhole' surgery, and so thoracoscopy is not suitable in all cases. In addition, should complications be encountered, such as bleeding from an artery, then the surgeon may need to convert from a keyhole approach to open surgery.
Thoracoscopy is mainly used in the treatment of conditions that occur for no specific reason. Problems such as a primary lung tumor or a pericardial effusion are usually not the result of an inciting cause, and own to bad luck or a genetic inclination, thus a preventative strategy is not appropriate.
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