Outcomes and complications following medical thoracoscopy

Abstract

Introduction: Thoracoscopy is an invasive procedure that may be performed by physicians for the investigation of exudative pleural effusion using local anaesthesia, conscious sedation and a rigid thoracoscope. Objectives: We sought to evaluate the safety and outcome of thoracoscopy in Portsmouth Hospitals, UK, a dockyard city with high previous asbestos usage. Methods: Retrospective casenote, radiology and laboratory result analysis of patients undergoing thoracoscopy in our institution over a 12-month period. Results: Fifty-seven of 58 casenotes were available for analysis. Median (interquartile range) age was 73.0 (66.5-79.0) years and 44 (77.2%) were male. Median time with chest drain post-procedure was 3.0 (2.0-5.0) days, and length of stay (LOS) was 4.0 (2.0-8.0) days. Malignant histology was reported in 40 (70.2%), with 25 (62.5%) cases of mesothelioma. There were no deaths related to the procedure. Hospital-acquired infection (HAI) occurred in six (10.5%: pneumonia four, empyema two), all had malignancy. The presence of HAI significantly prolonged the LOS 9.0 (7.5-23.5) vs no HAI 4.0 (2.0-7.0) days; P = 0.006). Four patients died within 1 month of the procedure, three had a malignant diagnosis, all had suffered HAI. Trapped lung (persistent hydropneumothorax 5 days post-procedure) occurred in 11 (19.2%), six of whom had benign histology. Performance status (European Cooperative Oncology Group) prior did not differ with reported histological type: benign 2.0 (2.0-2.0), malignant 2.0 (2.0-3.0), P = 0.170. Conclusions: Serious complications following thoracoscopy are rare. HAI is associated with malignancy and prolonged hospital stay. Benign histology may still confer significant morbidity.Please cite this paper as: Brims FJH, Arif M and Chauhan AJ. Outcomes and complications following medical thoracoscopy.

Non‐specific pleuritis in patients with active malignancy

“…Our study showed a large number of patients, with active malignancy who were diagnosed with non‐malignant pleural effusions by pleuroscopy (58%). Surprisingly, this is comparable to the prevalence of malignancy in other studies of pleuroscopy where the patient population was more general . Review of clinical and radiographical data was sufficient to reach a diagnosis in 70% of patients, the majority of which were related to cancer therapy.…”

Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital

“…Serious complications following thoracoscopy are rare (Brims et al [21]). The procedure is generally considered to be safe and well-tolerated, especially with semi-rigid instruments with no reported mortality to date (Lee and Colt [22]; Mohan et al [23]).…”

Feasibility and Safety of Fiber Optic Micro-Imaging in Canine Peripheral Airways

“…Although thoracoscopy is able to determine a clear diagnosis and make pathological classifications of these lesions, it requires specialized technology and has high risk, even mortality [4]. This is less likely to be used as the sole diagnostic instrument.…”

“…However, endoscopic information often fails to successfully detect peripheral airways smaller than 2 mm in diameter [3]. In addition, due to challenging technology and the potential for severe complications, thoracoscopy is not commonly used as a diagnostic tool alone [4], [5].…”