A thoracoscopy is a procedure used to diagnose pleural effusion, a condition where fluid builds up around the lungs. It's also known as a medical thoracoscopy or local anaesthetic thoracoscopy. 

During the procedure a small, thin camera called a scope is passed between your ribs into your chest. This allows your doctor to:

• examine the lung and its lining (pleura)
• drain any fluid from around the lung
• take small tissue samples (biopsies) 
• apply medicines such as talc to help stop the fluid from coming back 

Sometimes, a small tube called an indwelling pleural catheter (IPC) is left in place to help drain fluid over time, if we think the fluid is likely to return.  

About pleural effusion

The space between your lung and chest wall is called the pleural cavity or pleural space. It's made up of 2 thin layers (membranes). One layer lines the lung and the other lines the chest wall.

These layers are close together. They usually have a small amount of fluid in the space between them (about 15 to 30ml).

For some people, a larger amount of fluid can collect in this space. This is called pleural effusion. 

A thoracoscopy is used to diagnose pleural effusion when fluid sampling alone (thoracocentesis) does not provide enough information. 

Risks of a thoracoscopy

A thoracoscopy is usually very safe, but like all procedures there are some risks.  

• You may feel some discomfort during or after the procedure. We'll give you pain relief to help with this. 
• There is a risk of infection, this affects about 5 in 100 people. This usually resolves with antibiotics, but rarely surgery may be needed. 
• An air leak from the lung may develop. If this happens you may need a chest drain for 1 or 2 days after the procedure, but this usually settles by itself over a few days. 
• If medical talc is used, it's quite common to develop a fever. This usually settles with paracetamol. Rarely, the talc can cause a reaction in the lung and lead to breathlessness.
• Bleeding or damage to internal organs is rare. If this happens, an operation may be needed. 

Any medical procedure carries a small risk to life. Very rarely, a thoracoscopy can cause death because of complications from the procedure. This happens to less than 1 in 1,000 people.  

Other treatment options

A similar procedure called a video-assisted thoracoscopic surgery (VATS) may be done instead. This requires a general anaesthetic, which may not be suitable if you have other medical conditions. 

Giving your permission (consent) 

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment. 

Read more about our consent process. 

Preparing for a thoracoscopy

Before the procedure you'll have:

• blood tests
• swabs taken to check for MRSA and COVID-19

You'll be sent a seperate appointment for these tests. 

For the procedure, you'll be given sedation medicine that will help you relax and make you feel sleepy. 

If your doctor tells you that you're likely to leave hospital on the same day, please arrange for someone to bring you in and take you home afterwards. You should not be alone overnight due to the effects of sedation. 

Even if you’re told that you'll likely leave hospital on the same day, please bring an overnight bag in case you need to stay. 

Changes to your medicines 

You should let us know if you are taking any blood thinning medicines as you'll need to stop taking these before the procedure. This includes: 

• warfarin
• clopidogrel
• ticagrelor 
• edoxaban 
• rivaroxaban
• apixaban
• dabigatran

Eating and drinking instructions

You'll need to fast (not eat or drink) for 4 hours before the procedure. You'll be given more information about this. 

On the day of the procedure

Your doctor will talk to you about the procedure and go through the consent form. You'll have the chance to ask any questions you have. 

We'll place a small plastic tube called a cannula into a vein, usually in the back of your hand. This allows us to give you sedation medicine and pain relief.   

You’ll be taken to the procedure room and asked to lie on your side on a bed. You’ll have pillows around you to make you as comfortable as possible.

Your blood pressure, pulse and oxygen levels will be monitored throughout. If needed, we can give you extra oxygen to help with your breathing. 

We’ll use an ultrasound to check the amount of fluid and make sure you still need the procedure.  

During the procedure

We make a small incision (about 1 to 2cm) in the side of your chest. This is where the scope is put through. A local anaesthetic is used to numb the area. 

We drain the fluid and take any biopsies if needed. This usually takes about 30 to 40 minutes. 

After the fluid is drained, and we can see your lung more clearly, we can decide how to finish the procedure. 

If the lung looks like it:

• will reinflate (after being compressed by the fluid) we'll insert a temporary drain into your chest. This helps remove any air and fluid immediately after the procedure. If we think the fluid might come back, we may use medical talc to help the lung attach to the chest wall. This helps seal the space around your lung and can reduce the chance of fluid building up again.
• will not reinflate, and the fluid is likely to return at a later date, we'll insert a longer-term drain, called an indwelling pleural catheter. This allows fluid to be drained at home when needed.

Your doctor will explain which option is likely before your procedure. 

After the procedure 

After the procedure, you’ll be taken to the recovery area and offered a drink and biscuits.  

You may feel some discomfort once the local anaesthetic wears off. We’ll prescribe you pain relief to help with this. 

You'll have either a temporary chest drain, or an indwelling pleural catheter. 

Temporary chest drain

The drain will be removed when the air and fluid has stopped draining. You can usually leave hospital on the same day, but some people need to stay overnight.  

Indwelling pleural catheter

You can usually leave hospital on the same day. Your healthcare team will explain how the catheter works, and how it will be managed at home. 

Important

Sedation can affect you for 24 to 48 hours. 

Please follow these instructions for the first 24 hours after your procedure. 

Recovery after leaving hospital

Your stitches will be removed by a district nurse. This usually happens about 7 days after a temporary drain is placed, and about 14 days after an indwelling pleural catheter. 

Getting your results

You'll be given an appointment to come back to clinic about 2 weeks after your procedure, where you'll get the results of the biopsy. We can then decide if you need any further treatment.

Only very occasionally does the biopsy not give us enough information and another test or X-ray may be needed.