Redo medical thoracoscopy is feasible in patients with pleural diseases - a series

Abstract

Previous pleural endoscopy is considered to be a relative contraindication to further medical thoracoscopy. We reviewed our experience in patients undergoing more than one thoracoscopy irrespective of the primary indication. From January 2001 to December 2006, patient baseline characteristics, endoscopic appearance and technique, volume of pleural fluid and final histological diagnosis were collated in all patients undergoing more than one thoracoscopy. The endpoints were morbidity and mortality related to the procedures, to compare the length of procedure time between pleural endoscopies in individual patients and the degree of difficulty of the second or subsequent thoracoscopic procedure. During this period, 29 patients underwent 'redo' thoracoscopy resulting in a total of 61 procedures (rate of 'redo' thoracoscopy; 9.1%). The mean time between thoracoscopies was 5.3+/-3.8 months. Although pleural adhesions were more common at the time of the subsequent procedure, it did not result in failure to induce a pneumothorax or perform the procedure. There was no difference in the duration of procedure between the primary and subsequent thoracoscopy (P=0.46), as well as no complications directly attributed to the repeat pleural endoscopy. Repeat medical thoracoscopy is technically feasible in patients with pleural disease without an associated increased morbidity and mortality.

Medical thoracoscopy in the management of tuberculous pleural effusion

“…55,57,90,91 In addition, in indeterminate cases, repeated medical thoracoscopy is feasible. 92 Thoracoscopy allows disruption of pleural adhesions and peeling/debridement of large membranes. It permits complete evacuation of fluid and air and facilitates early and complete expansion of the underlying lung.…”

History and clinical use of thoracoscopy/pleuroscopy in respiratory medicine

“…As already mentioned, autofluorescence video thoracoscopy or narrow-band imaging during semi-rigid pleuroscopy may help in future to avoid some of the falsenegative results [57][58][59]. However, repeated medical thoracoscopy/pleuroscopy is also feasible [85].…”

Advances in the investigation and treatment of pleural effusions

“…Complications include empyema and pleural bleeding, however, mortality is extremely low. A second medical thoracoscopy is possible in patients with pleural disease if indicated, without an increase in morbidity or mortality, although there is a greater number of adhesions the second time round [51].…”