Feasibility and safety of argon plasma coagulation as hemostatic tool during medical thoracoscopy

Medical thoracoscopy (MT) is a minimally invasive procedure used for diagnosing and managing undiagnosed pleural effusions. Argon plasma coagulation (APC) is a non-contact electrosurgical technique widely used in gastrointestinal and bronchoscopic procedures, yet its application in MT remains underreported. This study describes the APC technique during MT for hemostasis and evaluates its safety and feasibility.

We conducted a retrospective observational study of patients who underwent MT with APC at Mayo Clinic, Jacksonville, FL, between December 1, 2022 and April 4, 2024. Patient demographics, procedural details, and pleural fluid analysis were recorded. Hemostasis was achieved using a rigid APC applicator, with bleeding severity assessed using the Validated Intraoperative Bleeding Scale (VIOPS). Descriptive statistical analyses were performed.

Twenty patients (median age: 72 years) underwent MT with APC, primarily for recurrent pleural effusion (95%). Adhesiolysis was performed in 60% of cases, and pleural biopsies were obtained in 95%. The median pleural fluid volume removed was 642.5 mL. A single bleeding complication (5%) was recorded (VIOPS score ≥2). No cases of air embolism were observed. Histopathology revealed malignancy in 21.1% of biopsies.

MT with APC appears to be a safe and effective technique for achieving hemostasis following pleural biopsy, with a low complication rate. This study provides a foundation for future research on the role of APC in pleuroscopy and its potential advantages over conventional hemostatic techniques.