Thoracoscopy and pleural biopsy

Thoracoscopy is a test to look at the space between your lung and chest wall. This is the pleural cavity. You might have a thoracoscopy to check for signs of cancer, such as mesothelioma .

It is a small operation. The doctor uses a flexible tube with a light and camera attached. This is called a thoracoscope. They use it to take biopsies from the tissues that cover your lungs (pleura ).

The test can take around an hour. But you will be in the hospital longer. This is because you have checks before the test and need recovery time in the hospital afterwards.

Why you might have it

You have a thoracoscopy to look inside your chest to see possible areas of cancer.

Doctors use a thoracoscopy to help diagnose cancers such as lung cancer and mesothelioma. They might also do a thoracoscopy to:

• remove fluid and air from the space between the lung and chest wall
• take samples of tissue (biopsies) that cover your lung (pleura)
• put in a chest drain
• treat fluid on the lung (pleurodesis)

Preparing for a thoracoscopy

The hospital staff will give you instructions about preparing for the test and what to bring on the day. This includes when to stop eating and drinking. Tell your doctor or nurse if not eating might be a problem for you, for example, if you have diabetes.

Let the staff in the thoracoscopy department know if you're taking medicines that change how your blood clots. This includes:

• aspirin
• clopidogrel
• arthritis medicines
• warfarin or heparin
• apixaban or rivaroxaban

You might need to stop taking this type of medicine a number of days before your thoracoscopy. Your doctor or nurse will tell you when you should stop. They will also tell you if you need to stop taking other medicines. 

You usually have a thoracoscopy with a local anaesthetic and sedation to make you drowsy. Or you might have this under a general anaesthetic, which means you are asleep. Your nurse or doctor will explain what will happen and give you specific instructions beforehand. 

What happens

When you arrive a nurse will check your weight, blood pressure, temperature, heart and breathing rate. The nurse will also ask you to:

• change into a hospital gown
• take off any jewellery (except for a wedding ring)
• take off makeup, including nail varnish

You meet the doctor who will explain the procedure and ask you to sign a consent form. This is a good time to ask any questions you may have.

If you are having a general anaesthetic you may need more preparation beforehand. You will also meet the anaesthetist. They look after you while you are asleep. Your nurse and doctor will explain what to expect. 

Having a thoracoscopy with local anaesthetic and sedation 

You have a small tube called a cannula put into a vein in the back of your hand. You have sedation and pain relief medication through this tube. 

Your doctor cleans and then numbs the area using an injection of local anaesthetic where the tube goes in. Then they make a small cut (incision) in your chest wall between 2 ribs. They put a flexible tube with a light and camera attached (thoracoscope) into the incision. 

A camera at the end of the tube connects to a large screen. The doctor can see pictures of the inside of your chest on the screen. They can examine the area between your lungs.

Using special surgical instruments through the thoracoscope, the doctor can take a biopsy of the tissues that cover the lungs. They send the sample to a laboratory to see if there are any cancer cells.

At the end, your doctor removes the thoracoscope and puts a tube in the incision in the chest. The tube is attached to a bottle. This is so that any remaining fluid and air can drain from your chest. They stitch the tube, so it doesn’t come out.

After the test

Your nurse regularly checks your breathing, pulse, and blood pressure. And also checks the chest drain. When you are less sleepy, you can try something to eat and drink. This may be about an hour after the test, but for some people this can be longer. 

You might be able to go home several hours later. But some people need to stay in hospital for 1 to 2 days. This depends on how quickly you recover from the test. You can usually go home after your doctor removes the chest tube. You may have a chest x-ray before they remove the tube. Your nurse will give you more information about the chest drain and when you can go home.  

If you have sedation or a general anaesthetic and go home the same day, you’ll need someone with you. This is so they can take you home and stay with you overnight. For 24 hours after, you shouldn’t:

• drive
• drink alcohol
• operate heavy machinery
• sign any legally binding documents

Possible risks

A thoracoscopy is a very safe procedure. Your nurse will tell you who to contact if you have any problems after your test. Your doctors will make sure the benefits of having a thoracoscopy outweigh any possible risks.

Some of the possible risks include:

Bleeding

There is a risk of bleeding. Contact your hospital 24-hour advice line if your wound starts to bleed, you have chest pain or if your breathing gets worse.

Infection

Contact your doctor or hospital 24-hour advice line if your wound is red and feels hot. Let them know if you have a high temperature or feel feverish. You might need antibiotics to treat an infection.

Collapsed lung (pneumothorax)

Air can collect in the space around the lung and make it collapse. But this is rare. Contact your hospital 24-hour advice line straight away if you have shortness of breath or chest pain. Your doctor might need to put a tube into the lung for a few days until the lung expands again.

Pain

You may feel sore and have some pain around the incision site for a few days after the test. You’ll be given painkillers to help with this. Contact your hospital 24-hour advice line if your pain doesn't improve. 

Getting your results

You should get your biopsy results within 1 or 2 weeks. The doctor may be able to let you know if they have seen any abnormal areas that have been sent to the laboratory. Contact the doctor who arranged the test if you haven’t heard anything after a couple of weeks.

Waiting for results can be a worrying time. You might have the contact details of a specialist nurse who you can speak to for information and support if you need to. It may also help to talk to a close friend or relative about how you feel. 

More information

We have more information on tests, treatment and support if you have been diagnosed with cancer.