The value of thoracoscopy in the diagnosis and treatment of diseases affecting the pleura and lung

Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion

“…After the decline of thoracoscopic interventions as a treatment for TB, some centres in continental Europe continued to use thoracoscopy as a diagnostic and therapeutic tool in other disorders, such as pneumothorax and pleural effusion. Pioneers like SWIERENGA et al [2], BRANDT [3] and BOUTIN et al [4] confirmed its value in publications in the 1970s. In the UK and the USA, thoracoscopy was not a widespread procedure, and open thoracotomy was the preferred procedure to obtain a diagnosis in pleuropulmonary disease.…”

Diagnostic Thoracoscopy

“…Others found a lower diagnostic yield of up to 50% for metastatic carcinoma of the pleura (33). Boutin and other authors proved that the diagnostic yield of thoracoscopy was much higher (94% to 96%) in all forms ofpleural disease (2,(33)(34)(35)(36)(37). Thoracoscopy provides the advantage of seeing the extent and the nature of the pleural abnormalities, and biopsies can be taken from macroscopically abnormal as well as from normal pleura.…”

“…Even after pleurodesis with tetracycline, which was especially popular in the United States, a recurrence rate of up to 45% has been reported (21,22). The high recurrence rate after conservative treatment for spontaneous pneumothorax has prompted some institutes to perform thoracoscopy in patients with first and recurrent pneumothorax, to select patients that would benefit from surgical resection of bullae (2,(24)(25)(26)(27) …”

“…Until the 1950s, thoracoscopy was almost only used for adhesiolysis in patients treated with a "therapeutic" pneumothorax for tuberculosis. Early in the 1970s, there was a renewed interest for thoracoscopy in The Netherlands, France, and Germany (2,3). Thoracoscopy was hardly popular in the United States and the United Kingdom until the recent development of disposable equipment for thoracoscopic intervention and video imaging.…”

“…Initially, thoracoscopy was used in patients with pleural fluid of unknown origin and pneumothorax (2). Later, several investigators used it for pulmonary biopsy (4)(5)(6)(7), and for the diagnosis and treatment of malignant pleurai effusions (7,8).…”