Thoracoscopy under regional anesthesia for the diagnosis and management of pleural disease

Over a 3 year period, 52 patients underwent thoracoscopy for the diagnosis and management of a variety of pleural diseases. In 46 of the 52 patients, thoracoscopy was performed under regional anesthesia. The procedure was associated with no operative deaths and essentially no morbidity. In all 52 patients, thoracoscopy averted the need for formal thoracotomy. Thoracoscopy proved valuable as (1) the ultimate diagnostic tool for determining the presence or absence of pleural malignancy in patients with recurrent pleural effusions; (2) a method for obtaining tissue in cases where cytologic study was inadequate for diagnosis; (3) a highly successful approach to chemical pleurodesis in patients with malignant pleural effusions, multiloculated effusions, or failed tetracycline pleurodesis; (4) a means for determining whether a loculated fluid collection was intrapleural or parenchymal in location when radiologic study had failed to clarify this; (5) a way to completely drain the pleural space in patients with multiloculated empyemas not amenable to tube thoracostomy; and (6) an alternative to open lung biopsy in the immunosuppressed patient with diffuse pulmonary infiltrates. Thoracoscopy is a safe, effective, and relatively simple procedure which can be easily performed under regional anesthesia, even in ill or elderly patients. It is an often overlooked alternative to thoracotomy and should be used more widely.