Thoracoscopy for Physicians : A Practical Guide

by D. R. Buchanan; E. Neville; S. R. Desai; A. Herbert; T. Treasure

• ISBN13: 9780340742112
• ISBN10: 0340742119
• Format: Paperback
• Copyright: 2004-07-15
• Publisher: Hodder Arnold Publishers

Summary

Thoracoscopy and biobsy have been developed as critical tools with which to diagnose pleural, and sometimes lung disease when simpler clinical and laboratory methods of examination have failed to yield a diagnosis. Thoracoscopy, which can be performed in an endoscopy suite or operating room,using simple sedation and local anesthesia and nondisposable equipment, is a useful, and less invasive, alternative to thoracotomy. Direct visualisation of thepleura with the thoracoscope achieves a diagnosis in over 90% of patients with tuberculosis or malignancy because biopsies can be taken fromareas that are seen to be macroscopically abnormal. Despite these advantages, the technique has until recently been vastly under-used. This book demonstrates clearly the diagnostic and therapeutic value of this technique, which can be undertaken under local anesthesia. Concise, practical andreadable, this volume covers the indications for thoracoscopic investigation of the thoracic cavity, and describes and illustrates the techniques involved , their contraindications and associated hazards. A handy aid for the residents training in thoracic medicine as well as for practicingrespiratory physicians.

Author Biography

E. Neville is Consultant Respiratory Physician, Respiratory Centre, Portsmouth Hospitals, Portsmouth, UK.

Table of Contents

Contributors	vi
Preface	vii
Abbreviations	ix
The undiagnosed pleural effusion	1	(1)
Introduction: the clinical dilemma	1	(1)
Pathophysiology	2	(2)
Pleural space compartments	4	(1)
Causes	5	(2)
Systematic approach and strategy	7	(1)
Initial evaluation of the patient	7	(3)
Imaging	10	(1)
Investigation	10	(6)
Other analyses	16	(3)
Diagnosis of specific conditions	19	(6)
Complications of aspiration/thoracentesis	25	(2)
Persistent undiagnosed pleural effusion	27	(1)
Conclusions and key points	27	(1)
References	28	(3)
Further reading	31	(1)
Useful websites	31	(2)
Radiology	33	(14)
Dr Buchanan
Sr Desai
Introduction	33	(1)
Indications for plain radiography	34	(4)
Indications for ultrasound	38	(2)
Computed tomography in differential diagnosis	40	(4)
Magnetic resonance imaging	44	(1)
Positron emission tomography	44	(1)
Conclusions and key points	45	(1)
References	45	(2)
Invasive investigations: percutaneous pleural biopsy	47	(10)
Introduction	47	(1)
Closed pleural biopsy	48	(1)
Closed image-guided pleural biopsies	48	(2)
Non-image guided or blind pleural biopsy: Abrams' and Cope's needle biopsies	50	(4)
Other invasive investigations	54	(1)
Conclusions and key points	54	(1)
References	55	(1)
Further reading	56	(1)
Current indications for thoracoscopy	57	(14)
Introduction	57	(1)
History and evolution of technique of thoracoscopy	58	(3)
Instrumentation	61	(1)
Clinical prerequisites	62	(1)
Indications	63	(3)
Contraindications to thoracoscopy	66	(1)
Consent	67	(1)
Conclusions and key points	68	(1)
References	69	(1)
Further reading	70	(1)
Technique of medical thoracoscopy	71	(16)
Introduction	71	(1)
Preparation	72	(5)
Procedure of thoracoscopy	77	(2)
Thoracoscopic anatomy	79	(3)
Investigations and management	82	(2)
Skills and requirements to get started	84	(1)
Conclusions and key points	85	(1)
References	85	(2)
Further reading	87	(1)
Therapeutic interventions and pleurodesis	87	(20)
Introduction	87	(2)
Management options for recurrent malignant effusions	89	(1)
Thoracoscopic intercostal tube drainage and instillation of sclerosing agent	90	(2)
Thoracoscopic pleurodesis/poudrage	92	(2)
Sclerosants	94	(5)
Pleural abrasion	99	(1)
Intercostal tube management	99	(2)
Post-pleurodesis considerations	101	(1)
Conclusions and key points	102	(1)
References	103	(3)
Further reading	106	(1)
Thoracoscopy, pleurodesis and post-procedure complications	107	(8)
Introduction	107	(1)
Early complications	108	(1)
Intermediate complications	109	(1)
Late complications	110	(1)
Safety and good clinical practice	111	(1)
Conclusions and key points	112	(1)
References	112	(1)
Further reading	113	(2)
Current practice in video-assisted thoracic surgery	115	(10)
T Treasure
Indications for cardiothoracic surgical advice	115	(1)
Definite indications for surgical thoracoscopy	116	(1)
Techniques	116	(1)
Major applications	117	(5)
Other applications	122	(1)
Complications of VATS thoracoscopy	122	(1)
Conclusions and key points	122	(1)
References	123	(1)
Further reading	123	(2)
Pathological findings	125	(16)
Dr Buchanan
A Herbert
Introduction	125	(1)
Macroscopic appearances at thoracoscopy	126	(1)
Cellular content of transudates and exudates	126	(1)
Reactive mesothelial cell	126	(3)
Pathology of non-malignant asbestos-induced pleural disease	129	(2)
Interpretation of histological reports on pleural tumours	131	(5)
Common non-malignant causes of chronic pleural effusion	136	(1)
Negative or inconclusive histology	137	(1)
Conclusions and key points	138	(1)
References	139	(1)
Further reading	140	(1)
Clinical risk assessment: reducing the risks of medical thoracoscopy	141	(16)
Introduction and background	141	(1)
Critical points in the process of care	142	(1)
Why things go wrong	143	(8)
How risks can be reduced	151	(2)
Communication with patient, relatives and primary care practitioner	153	(1)
Handover and continuity of care	154	(1)
Audit, clinical incident analysis, research and development	154	(1)
Conclusions and key points	155	(1)
References	155	(2)
Appendix: Equipment	157	(6)
Index	163