This page was reviewed under our medical and editorial policy by

Peter Baik, DO, Thoracic Surgeon

This page was updated on January 8, 2023.

What is thoracoscopy?

Thoracoscopy is a procedure used to look inside the patient's chest, right outside of the lungs. It’s performed with a thoracoscope, a thin, tubular instrument with a light and camera attached to it.

Thoracoscopy is considered a minimally invasive procedure, because only small incisions are needed. Typically, it’s used to detect or treat disease forming in the chest cavity or deliver medicine directly to an area in the chest. 

Often, a video is used to help guide the procedure.

Why thoracoscopy is performed

This procedure may be recommended for patients who are having difficulty breathing or are coughing up blood.

Thoracoscopy is often used to examine tissue that looks abnormal on an imaging test such as a chest X-ray or CT scan.

Thoracoscopy for lung biopsy

This procedure may be used to take biopsies of suspicious-looking:

  • Lung tissue
  • Lymph nodes
  • Tissue of the chest wall
  • Pleura (tissue that lines the lungs)

This might occur with lung cancer or mesothelioma.

Thoracoscopy surgery

Thoracoscopy is sometimes used to determine the etiology of the tumor or to resect tumors that have originated from other parts of the body. When the surgeon removes the portion of the lung that contains a tumor, it's called a wedge resection. If the tumor is bigger or a wedge resection can't be performed in cases of metastatic disease, the lobe of the lung may be removed (lobectomy). In some cases, the scope may be used to treat cancer in the esophagus or thymus gland.

Thoracoscopy to remove fluid around the lungs

Thoracoscopy can remove excess fluid that may be causing breathing difficulties. The doctor may send the fluid to a lab to check for signs of cancer or infection. If fluid is extracted but builds up again, a thoracoscope can be used to place medication in the chest cavity to stop another recurrence, a procedure called chemical pleurodesis.

Preparing for thoracoscopy

Prior to a thoracoscopy, make sure the care team is aware of all current medications, including any supplements, vitamins and herbs. Also, be sure to mention any allergies to medications.

The care team may instruct the patient to stop taking any medications that thin the blood, such as aspirin, for a number of days prior to the procedure and to stop eating or drinking anything in the hours beforehand.

What to expect during a thoracoscopy

The thoracoscopy procedure may be done on an outpatient basis (no overnight stay in the hospital) or on an inpatient basis (with a stay in the hospital for one or more nights).

With an inpatient thoracoscopy, the patient will likely receive general anesthesia via an intravenous line (IV). He or she will breathe through a tube placed in the throat that’s attached to a special machine. Outpatients will receive local anesthesia and a sedation to make the patient groggy. 

For the thoracoscopy itself, a small incision is made below the shoulder blade and the thoracoscope is inserted. Other small incisions may be needed, depending on what the doctor wants to accomplish. For instance, one may be made beneath the underarm on the same side to insert the instrument that takes a tissue sample for lab testing. If it’s necessary to remove fluid, an incision will be made in the lower chest wall and another tube inserted. The procedure takes about 30 to 90 minutes, depending on the patient's circumstances.

Thoracoscopy recovery

After the procedure, all incisions will be closed and the patient will go back to breathing on his or her own. The care team will monitor the patient closely to make sure there are no issues. As the anesthesia wears off, the patient is likely to feel woozy and experience some confusion for a period of hours and his or her mouth and throat will be numb. The patient won’t be able to eat or drink until the numbness subsides. At that point, he or she may experience hoarseness, coughing and/or a sore throat for about a day. The patient also may experience numbness or pain at the incision sites. 

If the patient undergoes outpatient thoracoscopy, he or she will likely be able to go home a few hours afterward but will need a ride home due to the lingering effects of anesthesia. The care team will provide the patient with postoperative instructions that need to be followed closely. It should include a list of signs of symptoms that require a call to the care team, such as:

  • Fever
  • Difficulty breathing
  • Chest pain
  • Coughing up blood

Thoracoscopy risks

Potential risks of thoracoscopy include:

  • Bleeding
  • Pneumonia (lung infection)
  • Infection at an incision site 
  • Pneumothorax (partial lung collapse)
  • The need for thoracotomy, a procedure in which the chest cavity is opened via a larger incision because the surgeon was unable to perform the procedure with the smaller cut 

Patients who have any symptoms following thoracoscopy may require a chest X-ray so the care team can look for pneumothorax or other issues.

Thoracoscopy vs. thoracotomy

During a thoracotomy, the chest cavity is opened via a larger incision than in a thoracoscopy. Thoracotomy may be performed if the surgeon is unable to perform the procedure with the smaller incision required of a thoracoscopy.

Thoracoscopy results

How soon patients get thoracoscopy results will depend on why the procedure was performed. For example, the patient may find out if any abnormal areas were detected right away. If a lung biopsy was taken, it may take a few days or longer to receive the report.

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