Medical Thoracoscopy

Joseph H. Skalski; Philippe J. Astoul; Fabien Maldonado

doi:10.1055/s-0034-1395796

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2014; 35(06): 732-743
DOI: 10.1055/s-0034-1395796

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medical Thoracoscopy

Authors

Joseph H. Skalski

¹Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
Philippe J. Astoul

²Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, France
Fabien Maldonado

¹Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota

Abstract

The burden of pleural diseases continues to rise and affects an increasingly complex and aging patient population. As such, thoracentesis is one of the most common procedures performed by respiratory physicians, as pleural fluid analysis can establish the diagnosis of pleural effusions in approximately 75% of the cases. When a diagnosis is not reached, options include image-guided biopsies, only possible when focal pleural lesions can be identified by computed tomography or ultrasound; closed pleural biopsies, associated with a relatively low diagnostic yield; and surgical pleural biopsies, which typically require general anesthesia and a hospital stay. Medical thoracoscopy addresses some of the limitations of these techniques, allows a comprehensive pleural examination and targeted pleural biopsies, and offers the possibility of treatment of recurrence in the same setting. As such, medical thoracoscopy is ideally positioned as a valuable tool in the diagnosis of unexplained exudative pleural effusions.

Keywords

pleuroscopy - thoracoscopy - pleural biopsies - pleurodesis - malignant pleural effusions - pneumothorax

Full Text

References

References
1 Light RW. Clinical practice. Pleural effusion. N Engl J Med 2002; 346 (25) 1971-1977
2 Lee P, Colt HG. Rigid and semirigid pleuroscopy: the future is bright. Respirology 2005; 10 (4) 418-425
3 Collins TR, Sahn SA. Thoracocentesis. Clinical value, complications, technical problems, and patient experience. Chest 1987; 91 (6) 817-822
4 Rahman NM, Ali NJ, Brown G , et al; British Thoracic Society Pleural Disease Guideline Group. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 (Suppl. 02) ii54-ii60
5 Moisiuc FV, Colt HG. Thoracoscopy: origins revisited. Respiration 2007; 74 (3) 344-355
6 Thomas Jr PA. A thoracoscopic peek: what did Jacobaeus see?. Ann Thorac Surg 1994; 57 (3) 770-771
7 Loddenkemper RMP, Noppen M, Lee P . Medical Thoracoscopy/Pleuroscopy: Manual and Atlas: Thieme; 2011
8 McLean AN, Bicknell SR, McAlpine LG, Peacock AJ. Investigation of pleural effusion: an evaluation of the new Olympus LTF semiflexible thoracofiberscope and comparison with Abram's needle biopsy. Chest 1998; 114 (1) 150-153
9 Lee P, Lan RS, Colt HG. Survey of pulmonologists' perspectives on thoracoscopy. J Bronchol Interven Pulmonol 2003; 10 (2) 99-106
10 Baron TH, Kamath PS, McBane RD. Management of antithrombotic therapy in patients undergoing invasive procedures. N Engl J Med 2013; 368 (22) 2113-2124
11 DePew ZS, Wigle D, Mullon JJ, Nichols FC, Deschamps C, Maldonado F. Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative. Chest 2014; 146 (2) 398-405
12 Chhajed PN, Kaegi B, Rajasekaran R, Tamm M. Detection of hypoventilation during thoracoscopy: combined cutaneous carbon dioxide tension and oximetry monitoring with a new digital sensor. Chest 2005; 127 (2) 585-588
13 Grendelmeier P, Tamm M, Jahn K, Pflimlin E, Stolz D. Propofol versus midazolam in medical thoracoscopy: a randomized, noninferiority trial. Respiration 2014; 88 (2) 126-136
14 Hallifax RJ, Corcoran JP, Ahmed A , et al. Physician-based ultrasound-guided biopsy for diagnosing pleural disease. Chest 2014;
15 Canto A, Rivas J, Saumench J, Morera R, Moya J. Points to consider when choosing a biopsy method in cases of pleurisy of unknown origin. Chest 1983; 84 (2) 176-179
16 Colt HG. Thoracoscopy. A prospective study of safety and outcome. Chest 1995; 108 (2) 324-329
17 Tassi GF, Marchetti GP, Pinelli V. Minithoracoscopy: a complementary technique for medical thoracoscopy. Respiration 2011; 82 (2) 204-206
18 Tassi G, Marchetti G. Minithoracoscopy: a less invasive approach to thoracoscopy. Chest 2003; 124 (5) 1975-1977
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 (5) 756-764
20 Sasada S, Kawahara K, Kusunoki Y , et al. A new electrocautery pleural biopsy technique using an insulated-tip diathermic knife during semirigid pleuroscopy. Surg Endosc 2009; 23 (8) 1901-1907
21 Yap KH, Phillips MJ, Lee YC. Medical thoracoscopy: rigid thoracoscopy or flexi-rigid pleuroscopy?. Curr Opin Pulm Med 2014; 20 (4) 358-365
22 Gao BA, Zhou G, Guan L, Zhang LY, Xiang GM. Effectiveness and safety of diagnostic flexi-rigid thoracoscopy in differentiating exudative pleural effusion of unknown etiology: a retrospective study of 215 patients. J Thorac Dis 2014; 6 (5) 438-443
23 Lee P, Hsu A, Lo C, Colt HG. Prospective evaluation of flex-rigid pleuroscopy for indeterminate pleural effusion: accuracy, safety and outcome. Respirology 2007; 12 (6) 881-886
24 Munavvar M, Khan MA, Edwards J, Waqaruddin Z, Mills J. The autoclavable semirigid thoracoscope: the way forward in pleural disease?. Eur Respir J 2007; 29 (3) 571-574
25 Rozman A, Camlek L, Marc-Malovrh M, Triller N, Kern I. Rigid versus semi-rigid thoracoscopy for the diagnosis of pleural disease: a randomized pilot study. Respirology 2013; 18 (4) 704-710
26 Khan MA, Ambalavanan S, Thomson D, Miles J, Munavvar M. A comparison of the diagnostic yield of rigid and semirigid thoracoscopes. J Bronchology Interv Pulmonol 2012; 19 (2) 98-101
27 Katlic MR, Facktor MA. Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases. Ann Thorac Surg 2010; 90 (1) 240-245
28 Lee P, Colt HG. Pleuroscopy in 2013. Clin Chest Med 2013; 34 (1) 81-91
29 Marel M, Zrůstová M, Stasný B, Light RW. The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. Chest 1993; 104 (5) 1486-1489
30 Boutin C, Viallat JR, Cargnino P, Farisse P. Thoracoscopy in malignant pleural effusions. Am Rev Respir Dis 1981; 124 (5) 588-592
31 Hooper C, Lee YC, Maskell N ; BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 (Suppl. 02) ii4-ii17
32 Prakash UB, Reiman HM. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc 1985; 60 (3) 158-164
33 Garcia LW, Ducatman BS, Wang HH. The value of multiple fluid specimens in the cytological diagnosis of malignancy. Mod Pathol 1994; 7 (6) 665-668
34 Light RW. Pleural effusions. Med Clin North Am 2011; 95 (6) 1055-1070
35 Harris RJ, Kavuru MS, Mehta AC , et al. The impact of thoracoscopy on the management of pleural disease. Chest 1995; 107 (3) 845-852
36 Page RD, Jeffrey RR, Donnelly RJ. Thoracoscopy: a review of 121 consecutive surgical procedures. Ann Thorac Surg 1989; 48 (1) 66-68
37 Maskell NA, Gleeson FV, Davies RJ. Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial. Lancet 2003; 361 (9366) 1326-1330
38 Chrysanthidis MG, Janssen JP. Autofluorescence videothoracoscopy in exudative pleural effusions: preliminary results. Eur Respir J 2005; 26 (6) 989-992
39 Schönfeld N, Schwarz C, Kollmeier J, Blum T, Bauer TT, Ott S. Narrow band imaging (NBI) during medical thoracoscopy: first impressions. J Occup Med Toxicol 2009; 4: 24
40 Scherpereel A, Astoul P, Baas P , et al; European Respiratory Society/European Society of Thoracic Surgeons Task Force. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J 2010; 35 (3) 479-495
41 Boutin C, Rey F. Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Part 1: Diagnosis. Cancer 1993; 72 (2) 389-393
42 Renshaw AA, Dean BR, Antman KH, Sugarbaker DJ, Cibas ES. The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Chest 1997; 111 (1) 106-109
43 Janes SM, Rahman NM, Davies RJ, Lee YC. Catheter-tract metastases associated with chronic indwelling pleural catheters. Chest 2007; 131 (4) 1232-1234
44 Boutin C, Rey F, Viallat JR. Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy. Chest 1995; 108 (3) 754-758
45 Davies HE, Musk AW, Lee YC. Prophylactic radiotherapy for pleural puncture sites in mesothelioma: the controversy continues. Curr Opin Pulm Med 2008; 14 (4) 326-330
46 Davies HE, Nicholson JE, Rahman NM, Wilkinson EM, Davies RJ, Lee YC. Outcome of patients with nonspecific pleuritis/fibrosis on thoracoscopic pleural biopsies. Eur J Cardiothorac Surg 2010; 38 (4) 472-477
47 DePew ZS, Verma A, Wigle D, Mullon JJ, Nichols FC, Maldonado F. Nonspecific pleuritis: optimal duration of follow-up. Ann Thorac Surg 2014; 97 (6) 1867-1871
48 Gopi A, Madhavan SM, Sharma SK, Sahn SA. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest 2007; 131 (3) 880-889
49 Valdés L, Alvarez D, San José E , et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med 1998; 158 (18) 2017-2021
50 Koegelenberg CF, Diacon AH. Pleural controversy: close needle pleural biopsy or thoracoscopy-which first?. Respirology 2011; 16 (5) 738-746
51 Diacon AH, Van de Wal BW, Wyser C , et al. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J 2003; 22 (4) 589-591
52 Utz JP, Ryu JH, Douglas WW , et al. High short-term mortality following lung biopsy for usual interstitial pneumonia. Eur Respir J 2001; 17 (2) 175-179
53 Vansteenkiste J, Verbeken E, Thomeer M, Van Haecke P, Eeckhout AV, Demedts M. Medical thoracoscopic lung biopsy in interstitial lung disease: a prospective study of biopsy quality. Eur Respir J 1999; 14 (3) 585-590
54 Dijkman JH, van der Meer JW, Bakker W, Wever AM, van der Broek PJ. Transpleural lung biopsy by the thoracoscopic route in patients with diffuse interstitial pulmonary disease. Chest 1982; 82 (1) 76-83
55 Marchandise FX, Vandenplas O, Wallon J, Francis C. Thoracoscopic lung biopsy in interstitial lung disease. Acta Clin Belg 1992; 47 (3) 165-169
56 Maldonado F, Moua T, Skalski J. Parenchymal cryobiopsies for interstitial lung diseases: a step forward in disease management. Respirology 2014; 19 (6) 773-774
57 Rodrîguez-Panadero F, Borderas Naranjo F, López Mejîas J. Pleural metastatic tumours and effusions. Frequency and pathogenic mechanisms in a post-mortem series. Eur Respir J 1989; 2 (4) 366-369
58 Postmus PE, Brambilla E, Chansky K , et al; International Association for the Study of Lung Cancer International Staging Committee; Cancer Research and Biostatistics; Observers to the Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer. J Thorac Oncol 2007; 2 (8) 686-693
59 Pilling JE, Dusmet ME, Ladas G, Goldstraw P. Prognostic factors for survival after surgical palliation of malignant pleural effusion. J Thorac Oncol 2010; 5 (10) 1544-1550
60 van Galen KP, Visser HP, van der Ploeg T, Smorenburg CH. Prognostic factors in patients with breast cancer and malignant pleural effusion. Breast J 2010; 16 (6) 675-677
61 Fysh ET, Waterer GW, Kendall PA , et al. Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion. Chest 2012; 142 (2) 394-400
62 MacEachern P, Tremblay A. Pleural controversy: pleurodesis versus indwelling pleural catheters for malignant effusions. Respirology 2011; 16 (5) 747-754
63 Zahid I, Routledge T, Billè A, Scarci M. What is the best treatment for malignant pleural effusions?. Interact Cardiovasc Thorac Surg 2011; 12 (5) 818-823
64 Davies HE, Mishra EK, Kahan BC , et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA 2012; 307 (22) 2383-2389
65 Xia H, Wang XJ, Zhou Q, Shi HZ, Tong ZH. Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis. PLoS ONE 2014; 9 (1) e87060
66 Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2004; (1) CD002916
67 Dresler CM, Olak J, Herndon II JE , et al; Cooperative Groups Cancer and Leukemia Group B; Eastern Cooperative Oncology Group; North Central Cooperative Oncology Group; Radiation Therapy Oncology Group. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest 2005; 127 (3) 909-915
68 Campos JR, Werebe EC, Vargas FS, Jatene FB, Light RW. Respiratory failure due to insufflated talc. Lancet 1997; 349 (9047) 251-252
69 Ferrer J, Montes JF, Villarino MA, Light RW, García-Valero J. Influence of particle size on extrapleural talc dissemination after talc slurry pleurodesis. Chest 2002; 122 (3) 1018-1027
70 Bridevaux PO, Tschopp JM, Cardillo G , et al. Short-term safety of thoracoscopic talc pleurodesis for recurrent primary spontaneous pneumothorax: a prospective European multicentre study. Eur Respir J 2011; 38 (4) 770-773
71 Janssen JP, Collier G, Astoul P , et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet 2007; 369 (9572) 1535-1539
72 Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med 2011; 26 (1) 70-76
73 Tremblay A, Mason C, Michaud G. Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis. Eur Respir J 2007; 30 (4) 759-762
74 Reddy C, Ernst A, Lamb C, Feller-Kopman D. Rapid pleurodesis for malignant pleural effusions: a pilot study. Chest 2011; 139 (6) 1419-1423
75 Folch E, Santacruz JF. Rapid pleurodesis: an outpatient alternative. Chest 2011; 140 (6) 1665-1666
76 MacDuff A, Arnold A, Harvey J ; BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 (Suppl. 02) ii18-ii31
77 Noppen M, Dekeukeleire T, Hanon S , et al. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects. Am J Respir Crit Care Med 2006; 174 (1) 26-30
78 Tschopp JM, Brutsche M, Frey JG. Treatment of complicated spontaneous pneumothorax by simple talc pleurodesis under thoracoscopy and local anaesthesia. Thorax 1997; 52 (4) 329-332
79 Tschopp JM, Boutin C, Astoul P , et al; ESMEVAT team. (European Study on Medical Video-Assisted Thoracoscopy). Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study. Eur Respir J 2002; 20 (4) 1003-1009
80 Bintcliffe O, Maskell N. Spontaneous pneumothorax. BMJ 2014; 348: g2928
81 Shen KR, Cerfolio RJ. Decision making in the management of secondary spontaneous pneumothorax in patients with severe emphysema. Thorac Surg Clin 2009; 19 (2) 233-238
82 Lee P, Yap WS, Pek WY, Ng AW. An audit of medical thoracoscopy and talc poudrage for pneumothorax prevention in advanced COPD. Chest 2004; 125 (4) 1315-1320
83 Waller DA, Forty J, Soni AK, Conacher ID, Morritt GN. Videothoracoscopic operation for secondary spontaneous pneumothorax. Ann Thorac Surg 1994; 57 (6) 1612-1615
84 Zhang Y, Jiang G, Chen C, Ding J, Zhu Y, Xu Z. Surgical management of secondary spontaneous pneumothorax in elderly patients with chronic obstructive pulmonary disease: retrospective study of 107 cases. Thorac Cardiovasc Surg 2009; 57 (6) 347-352
85 Colice GL, Curtis A, Deslauriers J , et al. Medical and surgical treatment of parapneumonic effusions : an evidence-based guideline. Chest 2000; 118 (4) 1158-1171
86 Brutsche MH, Tassi GF, Györik S , et al. Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy. Chest 2005; 128 (5) 3303-3309
87 Rahman NM, Maskell NA, West A , et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med 2011; 365 (6) 518-526
88 Noppen M, Herregodts P, D'Haese J, D'Haens J, Vincken W. A simplified T2-T3 thoracoscopic sympathicolysis technique for the treatment of essential hyperhidrosis: short-term results in 100 patients. J Laparoendosc Surg 1996; 6 (3) 151-159
89 Tassi GF, Davies RJ, Noppen M. Advanced techniques in medical thoracoscopy. Eur Respir J 2006; 28 (5) 1051-1059
90 Agarwal R, Aggarwal AN, Gupta D. Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions: a meta-analysis. Chest 2013; 144 (6) 1857-1867
91 Tomlinson JR, Sahn SA. Invasive procedures in the diagnosis of pleural disease. Semin Respir Med 1987; 9 (1) 30-36