Skip to main content
SpringerLink
Log in

Medical Thoracoscopy

  • Chapter
  • First Online:
Interventions in Pulmonary Medicine

  • 1564 Accesses

Abstract

Medical thoracoscopy, synonymous to “pleuroscopy,” refers to exploration of the pleural cavity in local anesthesia plus general sedation/analgesia. As opposed to video-assisted thoracoscopic surgery (VATS), general anesthesia or tracheal intubation is not necessary, and it can be performed either by trained pulmonologists or thoracic surgeons in a well-equipped endoscopy suite. Main indications are diagnosis of unexplained pleural effusions and treatment of recurrent pleural effusions or pneumothorax (pleurodesis, talc poudrage). Calibrated talc with particles no smaller than 10 μm (in order to prevent extrapleural dissemination with subsequent systemic complications) is mandatory whenever pleurodesis is attempted.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Moisiuc FV, Colt HG. Thoracoscopy: origins revisited. Respiration. 2007;74:344–55.

    Article  PubMed  Google Scholar 

  2. Marchetti GP, Pinelli V, Tassi GF. 100 years of thoracoscopy: historical notes. Respiration. 2011;82(2):187–92.

    Article  PubMed  Google Scholar 

  3. Cruise FR. The endoscope as an aid to the diagnosis and treatment of disease. Br Med J. 1865;8:345–7.

    Article  Google Scholar 

  4. Gordon S. Clinical reports of rare cases, occurring in the Whitworth and Hardwicke Hospitals: most extensive pleuritic effusion rapidly becoming purulent, paracentesis, introduction of a drainage tube, recovery, examination of interior of pleura by the endoscope. Dublin Q J Med Sci. 1866;41:83–90.

    Article  Google Scholar 

  5. Jacobaeus HC. The cauterization of adhesions in artificial pneumothorax treatment of pulmonary tuberculosis under thoracoscopic control. Proc R Soc Med. 1923;16:45–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Jacobaeus HC. Über die Möglichkeit, die Zystoskopie bei Untersuchung seröser Höhlen anzuwenden (“On the possibility of performing cystoscopy in the examination of serous cavities”). Münch Med Wschr. 1910;40:2090–2.

    Google Scholar 

  7. Roviaro GC, Varoli F, Vergani C, Maciocco M. State of the art in thoracoscopic surgery: a personal experience of 2000 videothoracoscopic procedures and an overview of the literature. Surg Endosc. 2002;16:881–92.

    Article  CAS  PubMed  Google Scholar 

  8. Gao BA, Zhou G, Guan L, Zhang LY, Xiang GM. Effectiveness and safety of diagnostic flexi-rigid thoracoscopy in differentiating exudative pleural effusion of unknown etiology: a retrospective study of 215 patients. J Thorac Dis. 2014;6(5):438–43.

    PubMed  PubMed Central  Google Scholar 

  9. Lee P, Mathur P. Advances in pleural diseases: what is the future for medical thoracoscopy? Curr Opin Pulm Med. 2016;22(3):297–308.

    Article  PubMed  Google Scholar 

  10. Agarwal R, Aggarwal AN, Gupta D. Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions: a meta-analysis. Chest. 2013;144(6):1857–67.

    Article  PubMed  Google Scholar 

  11. Thomas R, Karunarathne S, Jennings B, Morey S, Chai SM, Lee YC, et al. Pleuroscopic cryoprobe biopsies of the pleura: a feasibility and safety study. Respirology. 2015;20(2):327–32.

    Article  PubMed  Google Scholar 

  12. Rodriguez-Panadero F, Janssen JP, Astoul P. Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J. 2006;28:409–21.

    Article  CAS  PubMed  Google Scholar 

  13. Chhajed PN, Kaegi B, Rajasekaran R, Tamm M. Detection of hypoventilation during thoracoscopy: combined cutaneous carbon dioxide tension and oximetry monitoring with a new digital sensor. Chest. 2005;127(2):585–8.

    Article  PubMed  Google Scholar 

  14. Tassi G, Marchetti G. Minithoracoscopy. A less invasive approach to thoracoscopy. Chest. 2003;124:1975–7.

    Article  PubMed  Google Scholar 

  15. Hallifax RJ, Haris M, Corcoran JP, Leyakathalikhan S, Brown E, Srikantharaja D, et al. Role of CT in assessing pleural malignancy prior to thoracoscopy. Thorax. 2015;70(2):192–3.

    Article  CAS  PubMed  Google Scholar 

  16. Macha HN, Reichle G, von Zwehl D, Kemmer HP, Bas R, Morgan JA. The role of ultrasound assisted thoracoscopy in the diagnosis of pleural disease. Clinical experience in 687 cases. Eur J Cardiothorac Surg. 1993;7(1):19–22.

    Article  CAS  PubMed  Google Scholar 

  17. Froudarakis ME. Medical thoracoscopy: the green shapes of grey. Chest. 2015;147(4):869–71.

    Article  PubMed  Google Scholar 

  18. Marchetti G, Valsecchi A, Indellicati D, Arondi S, Trigiani M, Pinelli V. Ultrasound-guided medical thoracoscopy in the absence of pleural effusion. Chest. 2015;147(4):1008–12.

    Article  PubMed  Google Scholar 

  19. Astoul P, Maldonado F. Anesthetic drugs managed by pulmonologists during medical thoracoscopy: one size does not fit all! Respiration. 2014;88(4):265–7.

    Article  PubMed  Google Scholar 

  20. Tschopp JM, Purek L, Frey JG, Schnyder JM, Diaper J, Cartier V, et al. Titrated sedation with propofol for medical thoracoscopy: a feasibility and safety study. Respiration. 2011;82(5):451–7.

    Article  CAS  PubMed  Google Scholar 

  21. Grendelmeier P, Tamm M, Jahn K, Pflimlin E, Stolz D. Propofol versus midazolam in medical thoracoscopy: a randomized, noninferiority trial. Respiration. 2014;88(2):126–36.

    Article  CAS  PubMed  Google Scholar 

  22. DePew ZS, Wigle D, Mullon JJ, Nichols FC, Deschamps C, Maldonado F. Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative. Chest. 2014;146(2):398–405. doi:10.1378/chest.13-2113.

    Article  PubMed  Google Scholar 

  23. Corcoran JP, Psallidas I, Barker G, Sykes A, Hallifax RJ, Gleeson FV, et al. Reexpansion pulmonary edema following local anesthetic thoracoscopy: correlation and evolution of radiographic and ultrasonographic findings. Chest. 2014;146(2):e34–7.

    Article  PubMed  Google Scholar 

  24. Antony VB, Loddenkemper R, Astoul P, Boutin C, Goldstraw P, Hott J, et al. Management of malignant pleural effusions. Eur Respir J. 2001;18:402–19.

    Article  CAS  PubMed  Google Scholar 

  25. Froudarakis ME. Diagnostic work-up of pleural effusions. Respiration. 2008;75(1):4–13.

    Article  PubMed  Google Scholar 

  26. Villena V, Lopez Encuentra A, Echave-Sustaeta J, Alvarez Martinez C, Martín Escribano P. Prospective study of 1,000 consecutive patients with pleural effusion. Etiology of the effusion and characteristics of the patients. Arch Bronconeumol. 2002;38(1):21–6.

    Article  CAS  PubMed  Google Scholar 

  27. Kong XL, Zeng HH, Chen Y, Liu TT, Shi ZH, Zheng DY, et al. The visual diagnosis of tuberculous pleuritis under medical thoracoscopy: a retrospective series of 91 cases. Eur Rev Med Pharmacol Sci. 2014;18(10):1487–95.

    PubMed  Google Scholar 

  28. Thangakunam B. Are the days of closed pleural biopsy over? No. Lung India. 2015;32(6):641–3.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Maturu VN, Dhooria S, Bal A, Singh N, Aggarwal AN, Gupta D, et al. Role of medical thoracoscopy and closed-blind pleural biopsy in undiagnosed exudative pleural effusions: a single-center experience of 348 patients. J Bronchology Interv Pulmonol. 2015;22(2):121–9.

    Article  PubMed  Google Scholar 

  30. Diacon AH, Van de Wal BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, et al. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J. 2003;22(4):589–91.

    Article  CAS  PubMed  Google Scholar 

  31. Sakuraba M, Masuda K, Hebisawa A, Sagara Y, Komatsu H. Thoracoscopic pleural biopsy for tuberculous pleurisy under local anesthesia. Ann Thorac Cardiovasc Surg. 2006;12:245–8.

    PubMed  Google Scholar 

  32. Boutin C, Viallat JR, Cargnino P, Farisse P. Thoracoscopy in malignant pleural effusions. Am Rev Respir Dis. 1981;124:588–92.

    CAS  PubMed  Google Scholar 

  33. Loddenkemper R, Schönfeld N. Medical thoracoscopy. Curr Opin Pulm Med. 1998;4(4):235–8.

    Article  CAS  PubMed  Google Scholar 

  34. Maskell NA, Gleeson FV, Davies RJ. Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial. Lancet. 2003;361(9366):1326–30.

    Article  CAS  PubMed  Google Scholar 

  35. Metintas M, Ak G, Dundar E, Yildirim H, Ozkan R, Kurt E, et al. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest. 2010;137(6):1362–8.

    Article  PubMed  Google Scholar 

  36. Rahman NM, Ali NJ, Brown G, Chapman SJ, Davies RJ, Downer NJ, et al. Local anaesthetic thoracoscopy: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii54–60.

    Article  PubMed  Google Scholar 

  37. Egressy K, Murgu S. Medical thoracoscopy versus closed pleural biopsy: should this saga continue in the era of competency-oriented training? J Bronchology Interv Pulmonol. 2015;22(2):95–6.

    Article  PubMed  Google Scholar 

  38. Haridas N, Suraj KP, Rajagopal TP, James PT, Chetambath R. Medical thoracoscopy vs closed pleural biopsy in pleural effusions: a randomized controlled study. J Clin Diagn Res. 2014;8(5):MC01–4.

    PubMed  PubMed Central  Google Scholar 

  39. Boutin C, Arnaud A, Farisse P, Viallat J, Choux R, Aimard A, et al. [Pleural biopsies: complications and current value of Abram’s needle biopsy]. Poumon Coeur. 1975;31(6):317–21. [Article in French].

    Google Scholar 

  40. Villena V, Lopez Encuentra A, De Pablo A, Echave-Sustaeta J, Alvarez Martinez C, Martín Escribano P. Ambulatory diagnosis of the patients requiring a pleural biopsy. Study of 100 consecutive cases. Arch Bronconeumol. 1997;33(8):395–8.

    Article  CAS  PubMed  Google Scholar 

  41. Kern RM, DePew ZS, Maldonado F. Outpatient thoracoscopy: safety and practical considerations. Curr Opin Pulm Med. 2015;21(4):357–62.

    Article  PubMed  Google Scholar 

  42. Folch E, Santacruz JF. Rapid pleurodesis: an outpatient alternative. Chest. 2011;140:19885–6.

    Article  Google Scholar 

  43. Froudarakis ME, Klimathianaki M, Pougounias M. Systemic inflammatory reaction after thoracoscopic talc poudrage. Chest. 2006;129(2):356–61.

    Article  PubMed  Google Scholar 

  44. Rodriguez-Panadero F, Montes-Worboys A. Mechanisms of pleurodesis. Respiration. 2012;83(2):91–8.

    Article  PubMed  Google Scholar 

  45. Martín Díaz E, Arnau Obrer A, Martorell Cebollada M, Cantó Armengod A. Thoracocentesis for the assessment of lung cancer with pleural effusion. Arch Bronconeumol. 2002;38:479–84.

    Article  PubMed  Google Scholar 

  46. Rodriguez-Panadero F. Lung cancer and ipsilateral pleural effusion. Ann Oncol. 1995;6(Suppl 3):S25–7.

    Article  PubMed  Google Scholar 

  47. Sawabata N, Matsumura A, Motohiro A, Osaka Y, Gennga K, Fukai S, et al. Malignant minor pleural effusion detected on thoracotomy for patients with non-small cell lung cancer: is tumor resection beneficial for prognosis? Ann Thorac Surg. 2002;73:412–5.

    Article  PubMed  Google Scholar 

  48. Kondo H, Asamura H, Suemasu K, Goya T, Tsuchiya R, Naruke T, et al. Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer. J Thorac Cardiovasc Surg. 1993;106:1092–7.

    CAS  PubMed  Google Scholar 

  49. Dresler CM, Fratelli C, Babb J. Prognostic value of positive pleural lavage in patients with lung cancer resection. Ann Thorac Surg. 1999;67:1435–9.

    Article  CAS  PubMed  Google Scholar 

  50. Rodriguez-Panadero F. Medical thoracoscopy. Respiration. 2008;76(4):363–72.

    Article  PubMed  Google Scholar 

  51. Dhooria S, Singh N, Aggarwal AN, Gupta D, Agarwal R. A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions. Respir Care. 2014;59(5):756–64.

    Article  PubMed  Google Scholar 

  52. Chrysanthidis MG, Janssen JP. Autofluorescence videothoracoscopy in exudative pleural effusions: preliminary results. Eur Respir J. 2005;26(6):989–92.

    Article  CAS  PubMed  Google Scholar 

  53. Ishida A, Ishikawa F, Nakamura M, Miyazu YM, Mineshita M, Kurimoto N, et al. Narrow band imaging applied to Pleuroscopy for the assessment of vascular patterns of the pleura. Respiration. 2009;78(4):432–9.

    Article  PubMed  Google Scholar 

  54. Baas P, Triesscheijn M, Burgers S, van Pel R, Stewart F, Aalders M. Fluorescence detection of pleural malignancies using 5-aminolaevulinic acid. Chest. 2006;129(3):718–24.

    Article  CAS  PubMed  Google Scholar 

  55. Pikin O, Filonenko E, Mironenko D, Vursol D, Amiraliev A. Fluorescence thoracoscopy in the detection of pleural malignancy. Eur J Cardiothorac Surg. 2012;41(3):649–52.

    Article  PubMed  Google Scholar 

  56. Adusumilli PS, Eisenberg DP, Stiles BM, Hendershott KJ, Stanziale SF, Chan MK, et al. Virally-directed fluorescent imaging (VFI) can facilitate endoscopic staging. Surg Endosc. 2006;20(4):628–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Maskell NA. New directions in thoracoscopy: is the future fluorescent? Respiration. 2010;80(3):188–9.

    Article  CAS  PubMed  Google Scholar 

  58. Janssen JP, Schramel FMNH, Sutedja TG, Cuesta MA, Oosterhuis WP, Ostmus PE. Videothoracoscopic appearance of first and recurrent pneumothorax. Chest. 1995;108:330–4.

    Article  CAS  PubMed  Google Scholar 

  59. Tschopp JM, Brutsche M, Frey JG. Treatment of complicated spontaneous pneumothorax by simple talc pleurodesis under thoracoscopy and local anaesthesia. Thorax. 1997;52(4):329–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Noppen M, Dekeukeleire T, Hanon S, Stratakos G, Amjadi K, Madsen P, et al. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects. Am J Respir Crit Care Med. 2006;174:26–30.

    Article  PubMed  Google Scholar 

  61. Tschopp JM, Boutin C, Astoul P, Janssen JP, Grandin S, Bolliger CT, et al. Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study. Eur Respir J. 2002;20:1003–9.

    Article  CAS  PubMed  Google Scholar 

  62. Tassi GF, Davies RJO, Noppen M. Advanced techniques in medical thoracoscopy. Eur Respir J. 2006;28:1051–9.

    Article  CAS  PubMed  Google Scholar 

  63. Brutsche MH, Tassi GF, Gyorik S, Gokcimen M, Renard C, Marchetti GP, et al. Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy. Chest. 2005;128:3303–9.

    Article  PubMed  Google Scholar 

  64. Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, et al. Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest. 2000;118:1158–71.

    Article  CAS  PubMed  Google Scholar 

  65. Ravaglia C, Gurioli C, Tomassetti S, Casoni GL, Romagnoli M, Gurioli C, et al. Is medical thoracoscopy efficient in the management of multiloculated and organized thoracic empyema? Respiration. 2012;84:219–24.

    Article  PubMed  Google Scholar 

  66. Janssen JP, Boutin C. Extended thoracoscopy: a biopsy method to be used in case of pleural adhesions. Eur Respir J. 1992;5:763–6.

    CAS  PubMed  Google Scholar 

  67. Marquez-Martın E, Gonzalez Vergara D, Martin-Juan J, Romero Falcon A, Lopez-Campos JL, Rodriguez-Panadero F. Endobronchial administration of tranexamic acid for controlling pulmonary bleeding. A pilot study. J Bronchol Intervent Pulmonol. 2010;17:122–5.

    Article  Google Scholar 

  68. Boutin C, Rey F. Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Part 1: diagnosis. Cancer. 1993;72(2):389–93.

    Article  CAS  PubMed  Google Scholar 

  69. Neustein SM. Reexpansion pulmonary edema. J Cardiothorac Vasc Anesth. 2007;21(6):887–91.

    Article  PubMed  Google Scholar 

  70. Nakamura H, Ishizaka A, Sawafuji M, Urano T, Fujishima S, Sakamaki F, et al. Elevated levels of interleukin-8 and leukotriene B4 in pulmonary edema fluid of a patient with reexpansion pulmonary edema. Am J Respir Crit Care Med. 1994;149:1037–40.

    Article  CAS  PubMed  Google Scholar 

  71. Chang CY, Hung MH, Chang HC, Chan KC, Chen HY, Fan SZ, et al. Delayed onset of contralateral pulmonary edema following reexpansion pulmonary edema of a collapsed lung after video-assisted thoracoscopic surgery. Acta Anaesthesiol Taiwanica. 2009;47(2):87–91.

    Article  Google Scholar 

  72. Mahfood S, Hix WR, Aaron BL, Blaes P, Watson DC. Reexpansion pulmonary edema. Ann Thorac Surg. 1988;45:340–5.

    Article  CAS  PubMed  Google Scholar 

  73. Froudarakis ME, Pataka A, Makris D, Kouliatsis G, Anevlavis S, Sotiriou I, et al. Respiratory muscle strength and lung function in patients undergoing medical thoracoscopy. Respiration. 2010;80(3):220–7.

    Article  PubMed  Google Scholar 

  74. Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg. 1999;177:437–40.

    Article  CAS  PubMed  Google Scholar 

  75. Ukale V, Agrenius V, Widström O, Hassan A, Hillerdal G. Inflammatory parameters after pleurodesis in recurrent malignant pleural effusions and their predictive value. Respir Med. 2004;98(12):1166–72.

    Article  PubMed  Google Scholar 

  76. Maskell NA, Lee YC, Gleeson FV, Hedley EL, Pengelly G, Davies RJ. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170:377–82.

    Article  PubMed  Google Scholar 

  77. Arellano-Orden E, Romero-Falcon A, Martin Juan J, Ocaña Jurado M, Rodriguez-Panadero F, Montes-Worboys A. Small particle-size talc is associated with poor outcome and increased inflammation in thoracoscopic pleurodesis. Respiration. 2013;86(3):201–9.

    Article  CAS  PubMed  Google Scholar 

  78. Rodriguez-Panadero F, Segado A, Torres I, Martin J, Sanchez J, Castillo J. Thoracoscopy and talc poudrage induce an activation of the systemic coagulation system. Am J Respir Crit Care Med. 1995;151:A357.

    Article  Google Scholar 

  79. Boutin C. Methods and indications of pleuroscopy or medical thoracoscopy. Pneumonologie. 1999;12(1):16–9.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, Spain

    Francisco Rodriguez-Panadero MD

  2. Respiratory Diseases Lab, Instituto de Biomedicina de Sevilla (IBiS/HUVR), Sevilla, Spain

    Francisco Rodriguez-Panadero MD

Authors
  1. Francisco Rodriguez-Panadero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francisco Rodriguez-Panadero MD .

Editor information

Editors and Affiliations

  1. Clínica Corachan and Bellvitge, University Hospital, Barcelona, Spain

    Jose Pablo Díaz-Jimenez

  2. Pulmonary Department, Clinica y Maternidad Colon, Pulmonary Research Department, IIC Mar del Plata, Buenos Aires, Argentina

    Alicia N. Rodriguez

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Rodriguez-Panadero, F. (2018). Medical Thoracoscopy. In: Díaz-Jimenez, J., Rodriguez, A. (eds) Interventions in Pulmonary Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-58036-4_29

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-58036-4_29

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-58035-7

  • Online ISBN: 978-3-319-58036-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation