Medical thoracoscopy/pleuroscopy

Abstract

Medical thoracoscopy/pleuroscopy (MT/P), compared with surgical thoracoscopy (VATS), has the advantage that it can be performed under local anesthesia or conscious sedation, in an endoscopy suite, using nondisposable rigid (or semirigid) instruments. Thus, it is considerably less expensive. MT/P is a safe procedure which is even easier to learn than flexible bronchoscopy, provided that sufficient experience with chest-tube placement has been gained.The leading indications for MT/P are pleural effusions, both for diagnosis, mainly in exudates of unknown etiology, or for staging in diffuse malignant mesothelioma or lung cancer and for talc poudrage, which is the best conservative method today for pleurodesis. Spontaneous pneumothorax and earlyempyema are good indications, too.After a short review of the history, today's techniques, either with the rigid or the semirigid (semiflexible) instruments, are compared. The necessary equipment is described as well as the performance of MT/P including the anesthesia techniques underlocal anesthesia or conscious sedation.There are only few contraindications, an absolute one isobliteration of the pleural space. Relative contraindications are bleeding disorders and severerespiratory insufficiency.MT/P is a safe and effective investigation if certain standard criteria are fulfilled. Although the risks are low, it is important that adequate precautions are taken. Possible complications may occur before, during, or after MT/P. These are described in detail as well as measures of prevention.