Advice after your nerve block for surgery
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You have been advised to have a thoracoscopy, either to investigate the cause of your chest symptoms or to remove fluid that has been collecting around your lung, and to prevent this recurring if possible.
What is Medical Thoracoscopy?
Medical thoracoscopy is a procedure performed under local anaesthetic to look for any abnormalities in the space between your lungs and rib cage (the pleural space). It is performed by inserting a small camera, on the end of a telescope, into the pleural space between your ribs via a small hole approximately
1-2cm wide. Sometimes small samples (biopsies) from the lining of your chest wall can be taken, and fluid that collects around the lung (a pleural effusion) can be removed. Sometimes a pleurodesis can be performed, which involves trying to stick the lung to your ribcage to stop it collapsing again.
Please attend:
Endoscopy Suite, First floor, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey
Tel: 0300 613 4509 (8.00am – 6.00pm, Monday to Friday)
Please bring with you
• A list and supply of all your medications
• An overnight bag to stay in hospital
Before the procedure
Please do not eat or drink anything for at least 6 hours before the procedure. Please discuss with your doctor any medications that you take in advance, as there are some that you may need to stop before the procedure (for example warfarin, clopidogrel, rivaroxaban or apixaban).
You can take your usual medications (other than blood thinners) the morning of the procedure, with a very small amount of water.
A doctor will speak to you before the test, explain the procedure and ask you to sign a consent form if you are happy to proceed. Please let the doctor know if you have had any allergies to drugs or tests in the past.
What happens during the procedure?
A drip will be inserted into your arm, through which you may be given a sedative to relax you during the procedure, and painkilling medication if you need it. Some people do not remember the procedure afterwards because of the sedation.
You will be given oxygen via a small tube in your nose, and your pulse, oxygen level and blood pressure will be monitored throughout the procedure.
The procedure usually takes 45-60 minutes. You will be asked to lie on your side. An ultrasound machine will be used to establish where on your chest the camera will be inserted. An injection of local anaesthetic will be used to numb the area. This stings, but should make the area numb afterwards, so while you might feel some pushing, you should not feel pain.
The telescope will be inserted, fluid will be sucked out of the pleural cavity, and the doctor will use the camera to inspect the inside of your chest. If indicated, they may take some small biopsies. They may then insert a substance made with talc into the chest if they need to perform a pleurodesis. After the camera is removed, a thin plastic drain is often left in the hole to release air/ fluid from the chest as needed. The drain will be attached to a bottle with water in. This drain will usually be removed within 1-2 days.
You will be admitted to hospital until the drain is removed.
What are the potential risks and complications?
We try to ensure that your thoracoscopy is safe, but there are risks and potential complications. The most important are:
Pain: We aim to minimise this using local anaesthetic, injected painkillers during the procedure, and routine painkillers after the procedure. If you still have discomfort after you go home, simple painkillers such as paracetamol should help.
Breathlessness: This should settle soon after the procedure. We give oxygen and monitor you closely for this.
Bleeding: From the site where the camera is inserted, or from biopsy sites. A small amount of bleeding is common and most bleeding will settle on its own very quickly. We stop any blood thinning medications in advance to reduce bleeding risk. Very rarely a heavy bleed might occur, and may need a second procedure to stop it.
Infection: The entire procedure is done with a sterile technique to minimise risk of this. Infection risk following the procedure is 1in 100. If it occurs, you would likely need to stay in hospital for longer.
Pneumothorax: When air escapes from the lung into the pleural space. If small, this will resolve spontaneously. If a large leak occurs, the drain may need to stay in for longer, affecting the length of your inpatient stay.
Trapped Lung: When the lung does not re-inflate immediately on fluid drainage, because it has been compressed down for a while. In some instances we would insert a longer term drain which you might then go home with to try and resolve this.
Death: Rarely (less than 1 in 1000 cases) this procedure has been known to cause death. Risks are adjusted slightly depending on your level of fitness and general health.
What happens after the procedure?
Once the procedure is over, you will be moved to the recovery area where you will be monitored for a while. You will then be moved to the ward. A chest X-ray is usually done on the same day to check drain position. You will usually be discharged home within a day or two, once the drain has been removed.
What precautions should I take after the procedure?
Please ensure your chest drain is not pulled on, or tugged suddenly as it could fall out and may need to be reinserted.
How will I know the results of the test?
A doctor will speak to you about early findings once your sedation has worn off. However full results of biopsies will not be available until 5-10 days after the procedure so you will be invited to come to the outpatient clinic for full results, usually within a week of discharge home.
Advice upon discharge
Take simple painkillers such as paracetamol if you have discomfort. If you have stitches at your drain site, these will need removing within 7-10 days by the nurse at your GP practice.
Who to contact
If you have questions before or after the procedure, please contact one of our lung specialist nurses on 0300 6133535 (Monday –Friday 9.00am-5.00pm).
If you need other information, please contact the Respiratory Secretaries on 0300 613 4122 or 0300 613 6203
Out of hours, if you feel unwell or your breathing becomes challenging, please visit the Emergency Department.
Contact us
If you have any queries relating to this information, please contact the Respiratory medicine service.
About this information
Service:
Respiratory medicine
Reference:
W/029
Approval date:
28 October 2024
Review date:
1 November 2026
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.