What determines the choice of pleuroscope when performing a medical thoracoscopy (pleuroscopy)?

Updated: Apr 18, 2019
  • Author: Rajiv Malhotra, DO, MS, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

There are two different pleuroscopes: the rigid and the semirigid pleuroscopes. The choice of instrument depends on the indication of the procedure. Most procedures will be performed with a semirigid pleuroscope for the above-mentioned indications. The main indications for the use of a rigid pleuroscope involve trapped lung, lysis of thick adhesions, empyema, and pneumothorax. [5] These patients may be referred to a thoracic surgeon for a video-assisted thoracoscopic surgery.

Semirigid Pleuroscope

The semirigid pleuroscope is similar to a video bronchoscope. It consists of a handle with a shaft that measures 27 cm in length and 7 mm in diameter, as shown in the image below.

Insertion of semirigid scope through trocar. Insertion of semirigid scope through trocar.

The first 22 cm of the pleuroscope is rigid, with an additional 5-cm flexible scope on the distal end. The flexible end is operated through a level on the handle, similar to a flexible bronchoscope. The 2.8-mm working channel accommodates instruments such as biopsy forceps and needles.

Rigid Pleuroscope

The rigid pleuroscope includes a xenon light source, an endoscopic camera that transmits to the eyepiece of the telescope, and a video camera. It provides different angles of vision, both direct and oblique (30-50 degrees). The trocars come in different size diameters (3-13 mm). The traditional size of the forceps by which to obtain biopsies is 5 mm. However, 3-mm biopsy forceps have a yield similar to conventional forceps.


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