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It is usually performed at the time of a diagnostic thoracoscopy. [citation needed] Povidone iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost. [6] Chemical pleurodesis is a painful procedure, and so patients are often premedicated with a sedative and analgesics.
Pleurodesis is the obliteration of the pleural space, achieved by adhering the visceral pleura on the lung surface to the costal pleura of the chest wall. Adhesion is caused by inflammation and subsequent scarring of the pleural layers. Inflammation may be induced by either physical or chemical irritation.
Thoracoscopy is a medical procedure involving internal examination, biopsy and/or resection/drainage of disease or masses within the pleural cavity, [1] usually with video assistance. Thoracoscopy may be performed either under general anaesthesia or under sedation with local anaesthetic .
Video-assisted thoracoscopic surgery (VATS) is a type of minimally invasive thoracic surgery performed using a small video camera mounted to a fiberoptic thoracoscope (either 5 mm or 10 mm caliber), with or without angulated visualization, which allows the surgeon to see inside the chest by viewing the video images relayed onto a television screen, and perform procedures using elongated ...
A preventative procedure (thoracotomy or thoracoscopy with pleurodesis) may be recommended after an episode of pneumothorax, with the intention to prevent recurrence. Evidence on the most effective treatment is still conflicting in some areas, and there is variation between treatments available in Europe and the US. [ 12 ]
A technique called pleurodesis can be used to intentionally create scar tissue within the pleural space, usually as a treatment for repeated episodes of a punctured lung, known as a pneumothorax, or for pleural effusions caused by cancer. While this procedure usually generates only limited scar tissue, in rare cases a fibrothorax can develop. [6]
Pleural fluid cytology is positive in 60% of cases. However, in the remaining cases, pleural biopsy is required. Image guided biopsy and thoracoscopy have largely replaced blind biopsy due to their greater sensitivity and safety profile. CT guided biopsy has a sensitivity of 87% compared to Abrams' needle biopsy, which has a sensitivity of 47%. [9]
Pleural symphysis may be required to prevent nutritional and lymphocyte deficiencies that can result from repeated taps or persistent drainage. Chemical pleurodesis is generally an effective therapy for chylothorax, as is mechanical abrasion and talc poudrage. [118]