Pulmonology

Medical thoracoscopy or pleuroscopy is a minimally invasive procedure that allows access to the pleural space using a combination of viewing and working instruments. It also allows for basic diagnostic (undiagnosed pleural effusion and pleural thickening) and therapeutic procedures (pleurodesis and adhesiolysis) to be performed safely under local anaesthesia and conscious sedation.

Indications for Diagnostic Thoracoscopy

• Pleural effusion of unknown origin
• Suspected tuberculosis effusion
• Suspected malignancy with inconclusive cytology
• Recurrent pleural effusion
• Hemorrhagic pleural effusion
• Recurrent Pneumothorax

Indications for Therapeutic Thoracoscopy

• For pleurodesis in malignant, recurrent pleural effusion and recurrent pneumothorax
• To divide adhesions in recurrent / in persistent spontaneous pneumothorax and minimal loculated pleural effusion
• To perform pleural toilet in the fibrino purulent stage of empyema

Obstructive sleep apnoea (OSA) is a common respiratory disorder that comes under sleep disordered breathing. The following symptoms of sleep apnoea-snoring, choking or gasping during sleep, frequent sleep awakening, morning headache, fatigue, tiredness and excessive obstructive sleep apnoea are obese, short stature, hypothyroid, micrognathia and retrognathia.

The diagnosis of confirmation is polysomnography that is sleep study

• Treatment of obstructive sleep apnoea is multidisciplinary that may involve weight reduction, correction of upper positive airway pressure (CPAP), lifestyle modifications and more.
• Complications of obstructive sleep apnea are uncontrolled hypertension, fluctuating sugar level, uncontrolled asthma, heart attack, cerebrovascular accident, road traffic accident, cancer and depressive psychosis.

Pleural effusion treatment – pleurocentesis performed to remove the excess fluid build-up (space between your lungs and the wall of the chest). The physician might recommend for pleurocentesis When a they experience chronic cough, shortness of breath or chest pain. The treatment aids in the diagnosis, treatment of the lung and its function. Pleurocentesis can also be called thoracentesis. The treatment confirms or rules out diseases or infections like cancer, congestive heart failure, pneumonia or pulmonary hypertension.

How is it performed?

• After the patient evaluation (Chest X-ray), The physician performs an ultrasound to determine and find the apt location to place the needle that removes excess fluid and extracts the sample.
• The patient may be administered with a local anaesthetic to minimize the discomfort.
• After anaesthetic administration, with the help of ultrasound, your doctor carefully guides the needle through ribs and inside the chest.
• The needle removes the excess fluid present in the space. The doctor collects a fluid sample and tissue sample for further analysis and biopsy.
• A small bandage is placed to cover the place where the needle was inserted. A Chest X-ray may be recommended to examine the aftermath of the procedure.

A spirometry test measures a patient’s ability to inhale and exhale air through the lungs. Spirometry evaluation examines the ease and flow of air blown out from the lungs. Pulmonologists recommend spirometry tests if the patients suffer from cough, shortness of breath, wheezing.

The effectiveness of medicines administered to the patient can be checked in chronic respiratory conditions like Asthma, pulmonary fibrosis and COPD through spirometer.

Tube thoracotomy- A minimally invasive procedure where a thin plastic tube is inserted into the pleural space to remove excess space, fluid & other particles. With the support of ultrasound, fluoroscopy or computed tomography,

a thin tube is places into the chest allowing the lungs to function effectively. Apart from removing the excess fluid, tube thoracotomy aids to delivering medication into the pleural space.

How tube thoracotomy is performed?

• The doctor elevates the head of the patients’ bed by 30 – 60 degree and identifies the tube insertion site.
• Usually, the tube thoracotomy is performed under general anaesthesia to numb the site. Following anaesthesia, the doctor checks for the right area by inserting the needle deeply and makes an incision about 2 – 3 cm
• Using a surgical instrument named Kelly clamp, the area is widened slowly to gain the access of pleural space allowing the doctor to check for scar or mass tissue

• Through the incision site, the doctor inserts the chest tube. Draining of excess fluid through the tube confirms the proper insertion of the chest tube, if not the tube might be subjected to repositioning.
• Tubes are sutures at place allowing the seal to be airtight as possible. The incision site is then covered with the gauze pads. Once the procedure is completed, the patient is examined for chest X- ray to confirm the tube placement.