Answer
To prepare for the procedure, the pulmonologist can remove 500 ml of fluid from the pleural space through thoracentesis and induce a pneumothorax before inserting a trochar. Alternatively, the pulmonologist can make an intercostal incision that allows fluid to be aspirated freely once the trocar is inserted.
If malignancy is suspected, a single skin incision is made in approximately the fifth to seventh intercostal space along the lateral chest wall of the involved hemithorax. Pleural fluid is evacuated and pleural biopsies are obtained of the pleura. If the procedure is performed to visualize blebs and bullae in the lung apex, an incision in the fourth intercostal space is preferred.
Medical thoracoscopy is usually performed with a single-puncture technique, but can also use a double-puncture technique. For both, the pulmonologist visualizes the pleural space with a rigid or semirigid pleuroscope. Once the pleural cavity is entered, almost complete visualization of the parietal cavity is possible; only the posterior and mediastinal side of the lung cannot be seen.
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Biopsy forceps sampling parietal pleura.
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Talc pleurodesis on lung and parietal pleura.
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Bulky metastasis on parietal pleura.
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Examination for evidence of metastasis.
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Pleural adhesions on medical thoracoscopy.
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Patient positioning for medical thoracoscopy.
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Trocar insertion for medical thoracoscopy.
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Insertion of semirigid scope through trocar.
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Olympus semirigid pleuroscope.
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Olympus semirigid pleuroscope.
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Olympus semirigid pleuroscope.
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Semirigid pleuroscope in extension.
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Semirigid pleuroscope in flexion.
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Semirigid pleuroscope in neutral position.
