Current applications of nonvideo thoracoscopy

Video thoracoscopy has markedly improved the surgical team's ability to visualize the pleural cavity. As a result, traditional nonvideo thoracoscopy techniques have fallen into disuse. Although video technology has caused a resurgence of interest in thoracoscopy, and has made previously unimaginable endoscopic procedures feasible, it is not obviously superior to nonvideo thoracoscopy in all situations. The defining features of nonvideo thoracoscopy include an open tube type of thoracoscope (mediastinoscope), direct visualization of the pleural space through the thoracoscope, and passage of instruments through the thoracoscope. Potential clinical advantages of nonvideo thoracoscopy are related to the following features: simplicity of equipment, low cost, feasibility without one lung ventilation, feasibility under local or regional anesthesia, instrumentation through the thoracoscope (single incision), and ease of irrigation and suction. Nonvideo thoracoscopy is a simple and effective endoscopic technique for diagnostic pleural biopsy, pleurodesis of malignant effusions, debridement and drainage of empyemas, and evacuation of clotted hemothoraces. More complex thoracoscopic procedures require video thoracoscopy. Video capabilities have recently been added to several traditional open tube mediastinoscopes. In this way, it may be possible to combine some features of traditional nonvideo, open tube, thoracoscopy with video thoracoscopy.