History and clinical use of thoracoscopy/pleuroscopy in respiratory medicine

Abstract

Thoracoscopy was introduced over 100 years ago and for 40 years has been mainly used in the pneumothorax treatment of tuberculosis in those cases where pleuro-pulmonary adhesions prevented collapse of the lung. In the 1950s, the pneumothorax treatment of tuberculosis came to an end and thoracoscopy was used in a few centres by chest physicians as a diagnostic and therapeutic method in several pleuro-pulmonary diseases. In the 1990s, thoracic surgeons introduced the technique for minimally invasive surgery, known as "surgical thoracoscopy" or more precisely "video-assisted thoracic surgery" (VATS), which is performed under general anaesthesia with one-lung ventilation. In contrast, medical thoracoscopy/pleuroscopy can be performed under local anaesthesia or conscious sedation, in an endoscopy suite, using non-disposable rigid or semi-rigid instruments. Thus, it is considerably less invasive and less expensive. Today, medical thoracoscopy/ pleuroscopy is increasingly used by chest physicians, mainly in patients with pleural effusion or pneumothorax including talc poudrage as best conservative pleurodesis treatment. Meanwhile, the technique is considered to be one of the main areas of interventional pneumology.