[Value of thoracoscopy].

Abstract

Formerly used in active tuberculosis to divide pleuro-pulmonary adhesions and to complete therapeutic pneumothorax, thoracoscopy has now become the object of renewed interest. By introducing, after pneumoserosa and usually through the axilla, a fine trocar into the chest, the whole thoracic cavity, including parietal pleura, diaphragm, lung and lung fissures, mediastinum and pericardium, can be explored. This technique, performed under local rather than general anaesthesia or under neuroleptanalgesia, is innocuous, fairly cheap and effective. In addition, the patient is immobilized for only 4 or 5 days on average and surgery, which is much heavier, can be avoided in many cases. Thoracoscopy nowadays is mostly used: (1) to determine the cause of a chronic pleurisy unexplained after 3-4 weeks (positive results: 95-97% for cancer, 92% for tuberculosis); (2) to dry up pleural effusions by talc and drainage (satisfactory results in 90% of the cases); (3) to establish the pathophysiological diagnosis of spontaneous pneumothorax (bullae, blebs, adhesions, fistulae), to treat it with talc and with coagulation of small "bullae", or to decide in favour of surgery; (4) to perform lung biopsies which clinch the diagnosis in 95-97% of cases of diffuse interstitial pneumonia. The same technique is also used methodically and efficiently for optic and electronic microscopy, bacteriological or mycological examination, immunofluorescence, hormone receptor detection and study of organic particles or minerals. Thoracoscopy lies half-way between pure medical practice and surgery and deserves to be widely used again by pneumologists, provided they learn to master its technique by regular, assiduous and sufficient practice. Pneumologists do not become thoracoscopists at a moment's notice; it is a skill which must be included in their training.