Advanced medical thoracoscopy

Abstract

• Thoracoscopy is indicated in loculated parapneumonic effusion and empyema (Grade B). • Chest ultrasonography is the method of choice to identify loculations (Grade C). • Medical thoracoscopy, as a drainage procedure which is intermediate between tube thoracostomy and VATS, is significantly lower in cost and can avoid surgical thoracoscopy under general anaesthesia (Grade C). • It is essential that medical thoracoscopy is performed early in the course of empyema and advisable in particular for frail patients at high surgical risk (Grade C). • Thoracoscopic forceps lung biopsy is indicated in in patients with pleural effusion and associated lung disease (Grade C). • Thoracoscopic forceps lung biopsy is indicated to evaluate the visceral pleura involvement in mesothelioma (Grade C). • Thoracoscopic can safely be performed by trained interventional pulmonologists (Grade C). • Thoracoscopic sympathectomy carried out in specialised centres with sufficient expertise in close collaboration with thoracic surgeons (Grade C).