Medical Thoracoscopy For Physicians

Thoracoscopy and biopsy have developed as indispensable tools to diagnose pleural, and sometimes lung, disease when simple clinical and laboratory methods of examination have failed to yield a diagnosis. Thoracoscopy is most often undertaken by surgeons, but may also be performed by trained physicians. It takes place in an endoscopy or operating room using simple sedation, local anaesthesia and non-disposable equipment, and is a useful, less invasive alternative to thoracotomy. Direct visualisation of the pleura with the thoracoscope achieves a diagnosis in approximately 95 per cent of patients with tuberculosis or malignancy because biopsies are taken from areas seen to be macroscopically abnormal. Despite these advantages, the technique has until recently been vastly under-used in the UK when compared to practice in Europe and North America. This is now changing, however, with interest in the technique rekindled in parallel with rapid advances in equipment technology. The time is therefore right for the publication of this unique clinical guide to thoracoscopic practice. The book demonstrates the diagnostic and therapeutic value of this technique, which can be undertaken under local anaesthesia in a district general hospital. In addition to its use in the diagnosis of pleural disease, thoracoscopy has valuable therapeutic applications with the concomitant instillation of talc or other sclerosing agents into the pleural cavity for pleurodesis. Concise, practical and readable, this volume covers the indications for thoracoscopic investigation of the thoracic cavity, and describes and illustrates the techniques involved, their contraindications and associated hazards. Useful for MRCP candidates and specialist registrars in thoracic medicine seeking accreditation, it is also a handy aide-memoir for the practicing respiratory physician.