Open tube thoracoscopy: does it have a role in modern thoracic surgery?

To determine the role of open tube thoracoscopy in the diagnosis and management of thoracic diseases, a retrospective review of 48 patients was conducted. A mediastinoscope was used for open tube thoracoscopy. Eleven patients underwent diagnostic thoracoscopy, and 4 patients had thoracoscopy for cancer staging. All 11 diagnostic procedures yielded a diagnosis, and thoracic malignancies were staged accurately in all patients. Thirty-three patients underwent therapeutic thoracoscopy. Twelve therapeutic thoracoscopies were done for pneumothorax, 9 for loculated parapneumonic effusion or empyema, 4 for malignant effusions, 2 for traumatic hemothorax, 2 for wedge resection of peripheral lung cancers, and 4 for other indications. All but 1 therapeutic procedure were successful. Three patients experienced complications specific to thoracoscopy (empyema 1, prolonged air leak 1, chest tube site leakage 1). There were 5 deaths, but none were related to thoracoscopy. Open tube thoracoscopy is very effective for evacuation of loculated pleural fluid, pus, or blood, and it appears to have advantages over video thoracoscopy in these settings. Although open tube thoracoscopy is satisfactory for other simple pleural procedures and wedge resections of lung are possible, video thoracoscopic techniques are now preferred for these indications.