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Updated: Jan 20, 2026

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Single-trocar thoracoscopic pericardio-pleural fenestration under local anesthesia for malignant pleural effusion: a
Masatsugu Ohuchi1, Shuhei Inoue2, Yoshitomo Ozaki2
1Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan. oouchi.masatsugu.hy@mail.hosp.go.jp.
Background:
Pericardio-pleural fenestration by video-assisted thoracoscopic surgery is an efficient procedure for malignant pericardial effusion, but requires general anesthesia with single-lung ventilation.
Case Presentation:
A 43-year-old woman was referred with complaints of deteriorating dyspnea and orthopnea. Chest computed tomography revealed right massive pleural effusion and pericardial effusion. Echocardiography demonstrated collapse of both the right atrium and right ventricle due to cardiac tamponade. Semi-rigid thoracoscopic pleural biopsy and pericardio-pleural fenestration were successfully performed under local anesthesia via a single trocar, because surgical procedures under general anesthesia with single-lung ventilation might have been intolerable for the patient. Adequate biopsy specimens of pleura and pericardium and immediate relief of serious symptoms were obtained without perioperative complications. No recurrence of pleural or pericardial effusion was observed for 3 months postoperatively.
Conclusion:
Thoracoscopic pericardio-pleural fenestration under local anesthesia via a single trocar is feasible as an alternative approach in critically ill patients, allowing effective pericardial drainage, evaluation of the pleural cavity, and accurate biopsies of the pericardium and parietal pleura simultaneously.
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