What is the double-puncture technique for 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

With a double-puncture technique, the operator makes a second smaller incision along another intercostal space, which allows for insertion of a pleural trocar for accessory instruments. The second trocar is smaller, only 5 mm, and therefore only requires a 5-mm incision. The double-puncture technique is usually used when there is a need to lyse severe adhesions, control bleeding, suction large amounts of pleural fluid, or perform biopsies of the visceral pleura.

For parietal pleural biopsies, both abnormal- and normal-appearing pleura are sampled. Typically 4-6 biopsies of a suspicious lesion will establish a diagnosis. When malignancy is suspected and the endoscopic findings have been nonspecific, the number of biopsies should increase to 10-12 biopsies. [13]

When the procedure is complete, a chest tube is inserted through the original incision site. The lung is gently re-expanded by connecting the chest tube to a suctioning device. In the case of a trapped lung, the operator has the option of placing a normal chest tube with or without suction or placing a tunneled chest drain for outpatient management.


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