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.

Medical thoracoscopy/pleuroscopy: step by step

“…The main indications for medical thoracoscopy/pleuroscopy (table 1) are described in detail in [1] and are summarised in [4]. The European Respiratory Society School has been running hands-on courses on medical thoracoscopy/pleuroscopy for several years and has recently produced a video on the topic [5].…”

A glance at the history of uniportal video-assisted thoracic surgery

“…Therefore, Hans Christian Jacobaeus can be considered the first physician to employ the uniportal technique to enter the pleural cavity, perform biopsies and divide pleural adhesions. This event represents the commonly-accepted origin of thoracoscopy or pleuroscopy that was usually performed in spontaneously breathing patients using local anesthesia (7,8). This technique was unquestionably useful to investigate the normal and pathological aspects of the pleural cavity and the lung.…”

Uniportal thoracoscopic surgery: from medical thoracoscopy to non-intubated uniportal video-assisted major pulmonary resections

“…To perform thoracoscopy, he developed both a dedicated cystoscope and a dual port approach for visualization (8). His diagnostic thoracoscopies aided in our understanding of the normal and diseased appearances of the lung and pleural cavity (4). His counterparts in the 1920s, mainly Cutler, Davidson, Friedel and Drash, focused on uniportal techniques.…”

“…Even after the advent of antibiotics resulted in therapeutic thoracoscopy largely falling from favor, advances in anesthesia and intra-operative oxygenation made thoracoscopic biopsy an invaluable tool before falling into disuse (4).…”

“…While there are anecdotal reports of thoracoscopy use as early as 1866, Jacobaeus is widely acknowledged as the inventor of this technique. Notably, the pioneers of this approach usually performed thoracoscopy or pleuroscopy in spontaneously breathing patients using a local anesthetic (4).…”