CPT® Code 32650

Surgical thoracoscopy, commonly known as video-assisted thoracoscopic surgery (VATS), is a minimally invasive surgical procedure utilized primarily for performing pleurodesis, which can be achieved through mechanical or chemical means. This procedure involves the creation of three small incisions in the chest wall: one incision is typically made at the 7th or 8th intercostal space along the mid-axillary line, another in the posterior chest wall beneath the tip of the scapula, and a third in the anterior chest wall at the 5th or 6th intercostal space. A videothoracoscope, which is a specialized camera, is inserted through one of these incisions to provide visual access to the pleural cavity, while surgical instruments are introduced through the other incisions to perform the necessary interventions. In some cases, a single incision technique may be employed, referred to as pleuroscopy, where both the scope and instruments are passed through one incision. During the procedure, the pleura, which is the membrane surrounding the lungs, is inspected, and a chest tube is placed to facilitate drainage. A chemical sclerosing agent may be injected into the pleural space, inducing irritation and inflammation that leads to the pleurae adhering to one another, thereby preventing the recurrence of pleural effusion. The chest tube is temporarily closed to allow the sclerosing agent to distribute throughout the pleural space before being opened again to suction out the agent. Alternatively, mechanical abrasion of the pleura can be performed to achieve similar results. The chest tube may remain in place for several days post-procedure to ensure adequate drainage of any fluid that may accumulate in the chest cavity.