Medical thoracoscopy at 105. Anniversary

Abstract

Medical thoracoscopy (MT) for cases of exudative pleural effusion without a diagnosis by either clinical, radiological, laboratory or cytological investigation is performed as an established diagnostic method for the diagnosis of pleural diseases which has been performed routinely in many clinics. MT was done mainly with a rigid thoracoscope under mild sedation and local anesthesia in an endoscopy room with basic monitoring. It allows for the direct inspection of the pleural space and biopsies taken under direct vision. The diagnostic yield is in the order of 90-95% for malignant disease and can be as high as 100% for pleural tuberculosis. Additionally, MT can be performed for therapeutic as well as diagnostic purposes. Although MT remains an invasive procedure, complications are infrequently seen. Due to both the advantages of MT and the gradually increasing incidence of mesothelioma and malignant pleural disease, the use of MT for pleural effusions will be increasing in pulmonary clinics in coming years. Additionally MT will have some new developments; such as semirigid thoracoscopy, florescent or auto-florescent thoracoscopy, narrow-band imaging, thoracoscopy in patients without pleural effusion.

A Review of Medical Thoracoscopy and Its Role in Management of Malignant Pleural Effusion

“…Another indication where thoracoscopy provides both improved diagnostic yield and therapeutic benefits is in the management of tuberculous effusion. AFB smears and cultures of pleural fluid have been reported in multiple studies to have very poor sensitivity (<10% and <30%, respectively) in diagnosing TB pleural effusion [20,21]. Adenosine deaminase (ADA) sent from pleural fluid sample can increase the sensitivity of diagnosing TB effusion to 86% if there is a high pre-test probability of TB.…”

Utility of Semirigid Thoracoscopy in the Diagnosis of Recurrent Undiagnosed Pleural Effusion: A Tertiary Care Experience in Central India

“…Medical thoracoscopy is having high diagnostic efficiency in diagnosis of malignant pleural involvement, tuberculosis pleurisy, benign asbestos pleurisy, rheumatoid arthritis and drug-induced pleurisy. 1 Semirigid thoracoscope is a pleural endoscope having both flexible and rigid features making it useful mainly for diagnostic purposes. The body of semirigid thoracoscope is similar to that of a fibreoptic bronchoscope, to which specialists in chest diseases are accustomed.…”

“…Hence, its usage in patients with pleural adherence and thickening is risky. 1 Medical thoracoscopy is a minimally invasive procedure, which can be done as a day-care procedure under intravenous sedation and local anaesthesia in spontaneously breathing patient 2 . On the other hand, video-assisted thoracoscopic surgery (VATS) is conducted under general anaesthesia with single lung ventilation.…”