Unusual and infrequent indications for thoracoscopy.

A number of unusual or uncommon thoracoscopic indications have developed over the years. Pleural tuberculosis and blastomycosis, HIV infections, histoplasmosis, presenting as a nodular process have been diagnosed and treated. Fistulae or tube tract endoscopy may delineate whether a patient has persistence or recurrent carcinoma or tuberculosis through biopsy and culture techniques especially in the post pneumonectomy patient with an air leak. Thoracic diseases, including carcinoma, and mediastinal adenopathy and undiagnosed masses, are amenable to biopsy and possible resection. Foreign bodies may be removed with this technique. The utilization of thoracoscopy for diagnosis and treatment of pericardial processes has been utilized as well for placement of pacemakers. More recently, internal mammary artery to coronary artery bypass grafting has been performed by a few same surgeons with the endoscopic or VATS technique. Neurogenic indications include resection of the posterior sympathetic ganglia and vagectomy. Chylothorax therapy utilizing fibrin glue and liver and kidney biopsy may be performed.