Thoracoscopy, a study of 129 procedures

Abstract

Background: Medical thoracoscopy is a procedure which enables pneumologist to inspect the pleural space, perform biopsy, pleurodesis, and facilitates optimal chest tube placement and drainage in patients with pleural effusion. We made a retrospective analysis of the procedures, performed at the University Hospital Golnik between January 2002 and December 2007. Patients and methods: We evaluated 129 thoracoscopies, performed in 125 patients in a 5-year period. All patients had pleural effusion or a pleural mass, which failed to be diagnosed by less invasive diagnostic methods. In the study group there were 90 (72.0 %) men and 35 (28.0 %) women. Their median age was 63 years (from 28 to 81 years). All procedures were performed under local anaesthesia with a videothoracoscope Olympus A5252A. Pleurodesis was performed by insufflation of 5g of talc. Results: 78 (62.4 %) of patients had malignant infiltration of the pleura and 47 (37.6 %) had a benign pleural disease. The diagnostic accuracy of thoracoscopy was 91.5 %. The sensitivity in the diagnostics of malignant pleural disease was 86.1 %, the negative predictive value was 82.0 %. Talc pleurodesis was performed in 14 patients with malignant pleural infiltration. Complications were detected in 33 (26.4 %) patients, most of them were not severe. Severe complications, such as empyema, bronchopleural fistula, prolonged duration of drainage, perforation of the diaphragm and trapped lung, occurred in 8 (6.4 %) patients. 30-day mortality rate after the procedure was 0 %. Conclusions: Thoracoscopy has a high diagnostic yield with an acceptably low rate of complications. Nevertheless, it is an invasive procedure, which requires careful indications, patient’s consent, best surgical technique and an accurate postoperative follow up.