Abstract
Medical thoracoscopy/pleuroscopy (MT/P), compared with surgical thoracoscopy (VATS), has the advantage that it can be performed under local anesthesia or conscious sedation, in an endoscopy suite, using nondisposable rigid (or semirigid) instruments. Thus, it is considerably less expensive. MT/P is a safe procedure which is even easier to learn than flexible bronchoscopy, provided that sufficient experience with chest-tube placement has been gained.
The leading indications for MT/P are pleural effusions, both for diagnosis, mainly in exudates of unknown etiology, or for staging in diffuse malignant mesothelioma or lung cancer and for talc poudrage, which is the best conservative method today for pleurodesis. Spontaneous pneumothorax and early empyema are good indications, too.
After a short review of the history, today’s techniques, either with the rigid or the semirigid (semiflexible) instruments, are compared. The necessary equipment is described as well as the performance of MT/P including the anesthesia techniques under local anesthesia or conscious sedation.
There are only few contraindications, an absolute one is obliteration of the pleural space. Relative contraindications are bleeding disorders and severe respiratory insufficiency.
MT/P is a safe and effective investigation if certain standard criteria are fulfilled. Although the risks are low, it is important that adequate precautions are taken. Possible complications may occur before, during, or after MT/P. These are described in detail as well as measures of prevention.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Loddenkemper R, Mathur PN, Noppen M, Lee P. Medical thoracoscopy/pleuroscopy: manual and atlas. Stuttgart/New York: Thieme Publishers; 2011.
Antony VB, Loddenkemper R, Astoul P et al. Management of malignant pleural effusions. (ATS/ERS Statement). Am J Respir Crit Care Med. 2000;162:1987–2001, (and Eur Respir J. 2001;18:402–419).
Boutin C, Astoul P, Rey F, Mathur PN. Thoracoscopy in the diagnosis and treatment of spontaneous pneumothorax. Clin Chest Med. 1995;16:497–503.
Breen D, Fraticelli A, Greillier L, Mallawathantri S, Astoul P. Redo medical thoracoscopy is feasible in patients with pleural diseases – a series. Interact Cardiovasc Thorac Surg. 2009;8:330–3.
Bridevaux PO, Tschopp JM, Cardillo G, Marquette CH, Noppen M, Astoul P, Driesen P, Bolliger CT, Froudarakis ME, Janssen JP. Short-term safety of thoracoscopic talc pleurodesis for recurrent primary spontaneous pneumothorax: a prospective European multicentre study. Eur Respir J 2011;38:770–3.
Brutsche MH, Tassi GF, Györik S, et al. Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy. Chest. 2005;128:3303–9.
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;127:585–8.
Chrysanthidis MG, Janssen PJ. Autofluorescence videothoracoscopy in exudative pleural effusions: preliminary results. Eur Respir J. 2005;26:989–92.
Chung CL, Chen CH, Yeh CY, Sheu JR, Chang SC. Early effective drainage in the treatment of loculated tuberculous pleurisy. Eur Respir J. 2008;31:1261–7.
Diacon AH, Van de Wal BW, Wyser C, et al. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J. 2003;22:589–91.
Ernst A, Silvestri GA, Johnstone D. Interventional pulmonary procedures. Guidelines from the American College of Chest Physicians. Chest. 2003;123:1693–717.
Froudarakis ME. Diagnostic work-up of pleural effusions. Respiration. 2008;75:4–13.
Greillier L, Astoul P. Mesothelioma and asbestos-related pleural diseases. Respiration. 2008;76:1–15.
Györik S, Erni S, Studler U, Hodek-Wuerz R, Tamm M, Chhajed PN. Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. Eur Respir J. 2007;29:757–60.
Hersh CP, Feller-Kopman D, Wahidi M, Garland R, Herth F, Ernst A. Ultrasound guidance for medical thoracoscopy: a novel approach. Respiration. 2003;70:299–301.
Hooper CE, Lee YC, Maskell NA. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65:ii4–ii17.
Hooper CE, Lee YCG, Maskell NA. Setting up a specialist pleural disease service. Respirology. 2010;15:1028–36.
Janssen JP, Collier G, Astoul P, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet. 2007;369:1535–9.
Koegelenberg CF, Diacon AH, Bolliger CT. Parapneumonic pleural effusions and empyema. Respiration. 2008;75:241–50.
Lamb CR, Feller-Kopman D, Ernst A, et al. An approach to interventional pulmonary fellowship training. Chest. 2010;137:195–9.
Lee P, Mathur PN, Colt HG. Advances in thoracoscopy: 100 years since Jacobaeus. Respiration. 2010;79:177–86.
Lee P, Colt HG. Rigid and semirigid pleuroscopy: the future is bright. Respirology. 2005;10:418–25.
Loddenkemper R. Thoracoscopy – state of the art. Eur Respir J. 1998;11:213–21.
Mathur PN, Loddenkemper R. Medical thoracoscopy. Role in pleural and lung diseases. Clin Chest Med. 1995;16:487–96.
Medford AR, Bennett JA, Free CM, et al. Current status of medical pleuroscopy. Clin Chest Med. 2010;31:165–72.
Michaud G, Berkowitz DM, Ernst A. Pleuroscopy for diagnosis and therapy for pleural effusions. Chest. 2010;138:1242–6.
Migliore M, Giuliano R, Aziz T, Saad RA, Sgalambro F. Four-step local anesthesia and sedation for thoracoscopic diagnosis and management of pleural diseases. Chest. 2002;121:2032–5.
Munnavar M, Kan MA, Edwards J, Waqarrudin Z, Mills J. The autoclavable semirigid thoracoscope: the way forward in pleural disease? Eur Respir J. 2007;29:571–4.
Nasreen N, Mohammed KA, Brown S, et al. Talc mediates angiostasis in malignant pleural effusions via endostatin induction. Eur Respir J. 2007;29:761–9.
Noppen M, Dekeukeleire T, Hanon S, 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.
Rahman NM, Ali NJ, Brown G, et al. Local anaesthetic thoracoscopy: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii54–60.
Rodriguez-Panadero F, Janssen JP, Astoul P. Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J. 2006;28:409–22.
Schönfeld N, Schwarz J, Kollmeier J, et al. Narrow band imaging (NBI) during medical thoracoscopy: first impressions. J Occup Med Toxicol. 2009;4:24–8.
Tassi GF, Davies RJ, Noppen M. Advanced techniques in medical thoracoscopy. Eur Respir J. 2006;28:1051–9.
Tschopp JM, Rami-Porta R, Noppen M, Astoul P. Management of spontaneous pneumothorax: state of the art. Eur Respir J. 2006;28:637–50.
Tschopp JM, Purek L, Frey JG, Schnyder JM, Diaper J, Cartier V, Licker M. Titrated sedation with propofol for medical thoracoscopy: a feasibility and safety study. Respiration. 2011;82:451–7.
Vansteenkiste J, Verbeken E, Thomeer M, Van Haecke P, Eeckhout AV, Demedts M. Medical thoracoscopic lung biopsy in interstitial lung disease: a prospective study of biopsy quality. Eur Respir J. 1999;14:585–90.
Yoneda KY, Mathur PN, Gasparini S. The evolving role of interventional pulmonology in the interdisciplinary approach to the staging and management of lung cancer. Part III: diagnosis and management of malignant pleural effusion. Clin Lung Cancer. 2007;8:535–47.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Loddenkemper, R. (2013). Medical Thoracoscopy/Pleuroscopy. In: Ernst, A., Herth, F. (eds) Principles and Practice of Interventional Pulmonology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4292-9_59
Download citation
DOI: https://doi.org/10.1007/978-1-4614-4292-9_59
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-4291-2
Online ISBN: 978-1-4614-4292-9
eBook Packages: MedicineMedicine (R0)