A Three-Year Experience of Medical Thoracoscopy at A Tertiary Care Center of Himalayan Region

Document Type : Original Article


1 Pulmonologist, Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun

2 Pathologist, Department of Pathology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun

3 Resident, Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun


Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India.
Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study.
Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological & histopathological data of the patients were collected prospectively and analysed.
Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% (41/47). Malignancy was diagnosed histopathologically in 70.2% (33/47) patients (both primary & metastatic pleural carcinoma) and tuberculosis in 10.6% (5/47). There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients.
Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion.


1. Pugatch RD, Faling LJ, Robbins AH, Snider GL. Differentiation of pleural and pulmonary lesions using computed tomography. J Comput Assist Tomogr. 1978; 2:601-6.
2. Feinsilver SH, Barrows AA, Braman SS. Fiberoptic bronchoscopy and pleural effusion of unknown origin. Chest. 1986; 90:516-9.
3.  Poe RH, Israel RH, Utell MJ, Hall WJ, Greenblatt DW, Kallay MC. Sensitivity, specificity, and predictive values of closed pleural biopsy. Arch Intern Med. 1984; 144:325-8.
4. Ryan CJ, Rodgers RF, Unni KK, Hepper NG. The outcome of patients with pleural effusion of indeterminate cause at thoracotomy. Mayo Clin Proc. 1981; 56:145-9.
5. Metintas M, Ak G, Dundar E, Yildirim H, Ozkan R, Kurt E, et al. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest. 2010; 137:1362-8.
6. Rodriguez-Panadero F, Janssen JP, Astoul P. Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J. 2006; 28:409-22.
7. Emad A, Rezaian GR. Diagnostic value of closed percutaneous pleural biopsy vs pleuroscopy in suspected malignant pleural effusion or tuberculous pleurisy in a region with a high incidence of tuberculosis: a comparative, age-dependent study. Respir Med. 1998; 92:488-92
8. Weissberg D, Kaufmann M, Schwecher I. Pleuroscopy in clinical evaluation and staging of lung cancer. Poumon Coeur. 1981; 37:241-3.
9. Canto A, Ferrer G, Romagosa V, Moyya J, Bernat R. Lung cancer and pleural effusion. Clinical significance and study of pleural metastatic locations. Chest. 1985; 87:649-52.
10. Stefani A, Natali P, Casali C, Morandi U. Talc poudrage versus talc slurry in the treatment of malignant pleural effusion. A prospective comparative study. Eur J Cardiothorac Surg. 2006; 30:827-32.
11. Blanc FX, Atassi K, Bignon J, Housset B. Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study. Chest. 2002; 121:1677–83.
12. Rahman NM, Ali NJ, Brown G, Chapman SJ, Davies RJ, Downer NJ, et al. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010; 65:ii54-60.
13. Wang Z, Tong ZH, Li HJ, Zhao TT, Li XY, Xu LL, et al. Semi-rigid thoracoscopy for undiagnosed exudative pleural effusion: a comparative study. Chin Med J. 2008; 121:1384-9.
14. Mootha VK, Agarwal R, Singh N, Aggarwal AN, Gupta D, Jindal SK. Medical thoracoscopy for undiagnosed pleural effusions: experience from a tertiary care hospital in north India. Indian J Chest Dis Allied Sci. 2011; 53:21-4.
15. Asmita M, Rajesh V, Vishwam D, Babu S, Patel V, Lakshmanan H, et al. Value of semi rigid thoracoscopy in pleural effusion. Pulmon.2010; 12:43-5
16. Prabhu VG, Narasimhan R. The role of pleuroscopy in undiagnosed exudative pleural effusion. Lung India. 2012; 29:128-30.
17. Tscheikuna J, Silairatana S, Sangkeaw S, Nana A. Outcome of medical thoracoscopy. J Med Assoc Thai. 2009; 92:S19-23.
18. Otsuka K, Otoshi T, Fujimoto D, Kawamura T, Tamai K, Takeshita J, et al. Role of medical thoracoscopy making histological diagnosis of exudative pleural effusion. Am J Respir Crit Care Med. 2013; 187:A4299.
19. Dhooria S, Singh N, Aggarwal AN, Gupta D, Agarwal R. A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions. Respir Care. 2014; 59:756-64.
20. American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med. 2000; 162:1987-2001.
21.  Beheshtirouy S, Kakaei F, Mirzaaghazadeh M. Video assisted rigid thoracoscopy in the diagnosis of unexplained exudative pleural effusion. J Cardiovasc Thorac Res. 2013; 5:87-90.
22. Agarwal A, Prasad R, Garg R, Verma SK, Singh A, Husain N. Medical thoracoscopy: a useful diagnostic tool for undiagnosed pleural effusion. Indian J Chest Dis Allied Sci. 2014; 56:217-20.