Rigid versus semi‐rigid thoracoscopy for the diagnosis of pleural disease: A randomized pilot study

Rozman, Aleš; Camlek, Luka; Marc-Malovrh, Mateja; Triller, Nadja; Kern, Izidor

doi:10.1111/resp.12066

Cited by 63 publications

(58 citation statements)

References 20 publications

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“…This is in agreement with the experience of other interventional pulmonologists. 10,14 Despite a larger biopsy sample size with rigid thoracoscopy, the diagnostic yield was similar in the 2 groups, which is in congruity with the findings of Rozman et al 14 However, a recent study 24 does suggest a higher yield of larger biopsy sample size with semirigid thoracoscopy using a diathermic knife.…”

Section: Discussionsupporting

confidence: 75%

“…These reasons might also explain a higher proportion of adhesions encountered during thoracoscopy in our series (59%) compared with that in previous reports (between 30 and 40%) 22,23 and the failure to obtain a pleural biopsy sample. Also, the duration of the postprocedure tube drainage was longer because many of our subjects had tuberculous and parapneumonic effusions, which is in contrast to other reports 14 where the majority of the subjects had malignant effusions.…”

Section: Discussioncontrasting

confidence: 52%

“…However unlike the rigid thoracoscope, the semirigid instrument can be used only for pleural biopsy and usually cannot be used for adhesiolysis. In the only randomized controlled trial reported to date, 14 the diagnostic accuracy was 100% and 97.6%, respectively, for rigid and semirigid thoracoscopy. However, in that study, 14 subjects All values are expressed as n unless otherwise stated.…”

Section: Discussionmentioning

confidence: 99%

“…The duration of the procedure was longer than has been reported elsewhere. 14 The reasons for a longer duration were different in the two arms: included performance of adhesiolysis in the rigid arm and difficulty in obtaining pleural biopsy in the semirigid arm. Also the operators included fellows with variable amounts of experience with the instruments, which caused some bias even though the procedures were supervised by one of the consultants.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Another retrospective study 13 found comparable histologic yields of the rigid and the semirigid thoracoscopes. There is only one published randomized trial 14 comparing the yield of the 2 instruments wherein the authors found comparable diagnostic accuracy of the 2 instruments despite the smaller biopsy size obtained with the semirigid device.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

A Randomized Trial Comparing the Diagnostic Yield of Rigid and Semirigid Thoracoscopy in Undiagnosed Pleural Effusions

et al. 2013

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BACKGROUND: Thoracoscopic pleural biopsy increases the diagnostic yield of pleural effusions undiagnosed after thoracentesis and is superior to closed pleural biopsy. Medical thoracoscopy can be performed using the rigid thoracoscope or the semirigid thoracoscope (pleuroscope). In this randomized trial, we compare the efficacy and safety of the 2 thoracoscopes. METHODS: Subjects with undiagnosed exudative pleural effusions were randomly assigned to undergo pleural biopsy with either the rigid or the semirigid thoracoscope. The primary outcome was the diagnostic yield of the procedure, while the secondary outcomes were requirement of sedative/analgesic agents, scar size, biopsy sample size, and the operator's view of the procedure. RESULTS: Of the 145 screened subjects with exudative pleural effusions, 90 were randomized to undergo thoracoscopy with the 2 thoracoscopes (n ‫؍‬ 45 each). The diagnostic yield of rigid thoracoscopy was superior to semirigid thoracoscopy (97.8% vs 73.3%, P ‫؍‬ .002) on an intention-to-treat analysis but was similar (100% vs 94.3%, P ‫؍‬ .18) in those with successful biopsy. The requirement of sedative/analgesic agents was higher in the rigid thoracoscopy arm. The scar size was slightly larger (mean ؎ SD, 23.1 ؎ 4 vs 18.7 ؎ 3.2 mm, P ‫؍‬ .0001), whereas the biopsy sample size was distinctly larger in the rigid arm (mean ؎ SD, 13.9 ؎ 4.4 vs 4.4 ؎ 1.4 mm, P ‫؍‬ .001). The operator-rated visual analog scale score for the ease of taking a biopsy sample was significantly higher with the rigid instrument (mean ؎ SD, visual analog scale 86 ؎ 12 vs 79 ؎ 12 mm, P ‫؍‬ .01), while the quality of image was superior in the semirigid arm (mean ؎ SD, visual analog scale 88 ؎ 7 vs 92 ؎ 5 mm, P ‫؍‬ .002). The number of complications were similar in the 2 groups. CONCLUSIONS: Rigid thoracoscopy was found to be superior to semirigid thoracoscopy overall, but the diagnostic yield was similar if pleural biopsy could be successfully performed. Due to the small sample size, a larger study is required to define the usefulness and choice between the 2 procedures. (ClinicalTrials.gov registration NCT01726556)

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Section: Discussionsupporting

confidence: 75%