Thoracoscopy
Instead of making a wide
incision and spreading the ribs to inspect and operate in the chest,
a small scope, like the one at left, with a video camera attached can
be inserted through a one inch incision in the chest. Through this incision,
and one or two additional small incisions, the chest cavity can be visualized.
At right are some of
the instruments that can grasp and cut abnormal tissues inside the chest.
There are instruments that can apply an electrocautery current to tissues
to prevent bleeding, and there are instruments that can put down rows
of small staples with a cut inbetween the rows for bloodless incisions
into tissues. All of the surgeons movements and manipulations are seen
on a video screen in the operating room. Video tapes and still pictures
can even be made for future reference.
For example, at left
is a picture of a pulmonary bulla at the top of the lung. This picture
was taken using the thoracoscope. The outline of the ribs can be plainly
seen at the top two-thirds of the frame, normally appearing lung at
the very bottom, and the white colored bulges out of the lung are the
bullae. These are benign thin walled air sacs that often rupture, causing
a collapsed lung or pneumothorax. The treatment for an initial pneumothorax
is usually insertion of a tube between the ribs to drain the escaped
air out of the chest cavity. The chest tube also promotes inflammation
inside the chest, causing the lung to stick to the inside lining of
the chest cavity, helping to seal off the leaking bulla and preventing
further air leaks.
If a second pneumothorax
develops on the same side, or if the first pneumothorax does not stop
leaking with a chest tube, the bullae should be removed. At right we
can see that a piece of lung has been grasped, and a stapling device
has been applied to the lung. This device staples off the abnormal lung
tissue, preventing bleeding and excessive air leaks, and also cuts the
lung between rows of staples. Once the piece of lung has been completely
severed from the rest of the normal lung, it can be removed through
one of the small scope holes made between the ribs. To view a video
of a resection of a wedge of lung tissue by thoracoscopy, please click
here.