Thoracoscopy

What is LAVAT?

Local Anaesthetic Video Assisted Thoracoscopy (LAVAT), also known as medical thoracoscopy, is a minimally invasive diagnostic and therapeutic procedure used to assess pleural diseases and pleural fluid collections. Performed under local anaesthesia and conscious sedation, LAVAT allows for direct visualization of the pleural space, facilitating safe biopsies, fluid drainage, and pleurodesis. It is typically a day-care procedure performed in a hospital setting.

Why Choose LAVAT?

LAVAT offers many benefits over more invasive options like VATS (Video Assisted Thoracoscopic Surgery):

• Less invasive with minimal incisions

• Lower anaesthetic requirement

• Reduced complications such as re-expansion pulmonary oedema

• Accurate pleural biopsies and effective pleurodesis using talc

• Rapid recovery and outpatient management

LAVAT in Nashik is especially useful when previous ultrasound-guided thoracentesis has not yielded a diagnosis.

Who is Suitable for LAVAT?

LAVAT is ideal for patients with:

• Undiagnosed pleural effusion despite previous testing

• Need for pleural biopsy or pleurodesis

• Conditions unsuitable for general anaesthesia or surgical thoracoscopy

However, it is not recommended where extensive thoracic surgery is indicated.

Procedure Overview – What to Expect

LAVAT is often done under conscious sedation, although some cases may require short hospital admission. Here’s how the procedure unfolds:

• Patient is prepped and positioned.

• A small incision is made to insert the pleuroscope.

• Pleural fluid is drained, and pleural surfaces are inspected.

• Biopsies are taken under direct vision.

• Talc may be insufflated to perform pleurodesis, preventing fluid recurrence.

The procedure is generally well-tolerated, with minimal discomfort.

History of Thoracoscopy

Thoracoscopy was pioneered in 1910 by Hans-Christian Jacobaeus in Sweden. Initially used for treating tuberculosis, the technique evolved through the decades. Today, medical thoracoscopy (LAVAT) is performed by pulmonologists using advanced video-assisted technology. Surgical thoracoscopy (VATS) is still performed by thoracic surgeons, but LAVAT has become the preferred choice for diagnostic and therapeutic pleural interventions in patients who are unfit for surgery.

Medical Indications for LAVAT

LAVAT in Nashik is recommended for the following clinical scenarios:

• Undiagnosed Pleural Effusion
  Direct visualization of the pleura offers diagnostic accuracy greater than 90% in cases where thoracentesis or cytology fails.

• Malignant Pleural Effusion
  Allows therapeutic pleurodesis via talc insufflation, improving quality of life and reducing recurrence.

• Lung Cancer with Negative Cytology
  Enables accurate staging and avoids unnecessary surgeries.

• Suspected Malignant Mesothelioma
  Offers superior diagnostic yield compared to cytology, especially in early detection.

• Tuberculous Pleural Effusion
  Provides large tissue samples and facilitates drainage or adhesiolysis in select cases.

• Recurrent Benign Effusions
  Useful for managing heart failure-related, post-surgical, or nephrotic effusions.

• Empyema and Parapneumonic Effusions
  Selected cases with thin adhesions may benefit from early thoracoscopic drainage and lysis.

• Pneumothorax
  Offers diagnostic inspection and definitive pleurodesis in non-surgical candidates.

Contraindications for LAVAT

Absolute and relative contraindications must be carefully assessed:

• Absolute: Inability to safely access the pleural space

• Relative (can be managed prior to procedure):

  • Refractory cough

  • Hypoxia

  • Coagulopathy

  • Thrombocytopenia

Thoracic ultrasound can assist in identifying a safe pleural window. A minimum pleural separation of 10 mm is generally recommended.

Diagnostic Superiority of LAVAT

Compared to thoracentesis and closed needle biopsy, pleuroscopy in Nashik offers significantly better diagnostic clarity, allowing tailored treatment.

Therapeutic Benefits of LAVAT

• Talc Pleurodesis: Effective in >90% of cases

• Adhesion Lysis: Improves lung re-expansion

• Effusion Drainage: Better symptomatic relief

• Improved Functional Status: Enhances eligibility for cancer therapies

LAVAT at Dr. Mutha Hospital – Thoracoscopy in Nashik

Dr. Mutha Hospital is among the leading centers for LAVAT in Nashik, offering state-of-the-art video-assisted thoracoscopy under local anaesthesia. We ensure:

• High diagnostic accuracy

• Patient comfort and safety

• Personalized treatment approach

• Integration of LAVAT with broader respiratory care (like Bronchoscopy in Nashik and Sleep Study Diagnosis)