Answer
With the single-puncture technique, the pulmonologist inserts accessory instruments through the working channel of the pleuroscope. Parietal pleural biopsies, for example, can be done using illuminated forceps through a single point of entry. To enter the pleural cavity, an 8- to 10-mm skin incision is made parallel with and centered in the intercostal space selected. Blunt dissection is then performed with a straight scissor down to the parietal pleura. The trocar is gently pushed through the dissected pathway; with moderate pressure, it is pushed through the pleura (see the image below).
Any fluid remaining in the pleura is aspirated with a blunt flexible tube that is fed through the trocar sleeve. The tube is usually smaller than the track made into the pleural space to continue to allow for air to enter the thoracic cavity and induce a pneumothorax.
The insertion of the semirigid pleuroscope through the trocar is shown in the image below.
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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.
