Chest
Volume 108, Issue 2, August 1995, Pages 324-329
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Clinical Investigations; Articles; Thoracic Surgery
Thoracoscopy: A Prospective Study of Safety and Outcome

https://doi.org/10.1378/chest.108.2.324Get rights and content

Objective

To assess a standard classification of adverse events and evaluate the safety and long-term outcome of thoracoscopy in patients with pleural disease.

Design

Prospective nonrandomized cohort study.

Setting

The Pulmonary Special Procedures and Nd:YAG Laser Unit of the University of California San Diego Medical Center, San Diego.

Patients

Fifty consecutive patients undergoing thoracoscopy for diagnosis of pleural effusion or thickening, pleurodesis, or empyema drainage.

Intervention

A list of major and minor adverse events that could be temporally related to thoracoscopy performed for diagnosis or treatment of pleural processes was established before beginning this prospective study. Procedures were performed using multiple point-of-entry techniques and either local or general anesthesia. Most procedures were performed in the operating room using double-lumen intubation. Patients were seen daily during hospitalization and at least 7, 30, and 90 days after thoracoscopy. Long-term follow-up data were obtained by telephone calls, clinical visits, or medical chart reviews or all of these, until 12 months after procedures.

Measurements

Occurrence of major and minor adverse events possibly related to thoracoscopy was recorded prospectively. Demographic and clinical data, as well as efficacy and outcome after thoracoscopy, were also noted.

Results

Fifty-two procedures were performed in 50 patients. Median age was 60 years (range, 18 to 88 years). Thoracoscopy provided a diagnosis in 93% of patients with pleural disease of unclear origin. Pleurodesis by thoracoscopic talc insufflation was successful in 95% of cases and in 91% of patients with malignant pleural effusions still available for evaluation and follow-up examination 3 months after pleurodesis. Thoracoscopic drainage of empyema was successful in six of seven patients and led to referral for open decortication in one. There were no procedure-related deaths or intraoperative accidents. Open-chest surgery intervention was never required. Only 1 major adverse event occurred: a patient with scleroderma and trapped lung had recurrent pleural effusion requiring chest tube drainage 1 week after hospital discharge. Minor adverse events, however, were noted in ten instances (19%). These included fever after talc pleurodesis, asymptomatic pneumothorax after chest tube removal, and minor wound infection in a patient with empyema.

Conclusion

Using the proposed classification of major and minor adverse events, prospective evaluation demonstrated the safety, diagnostic utility, and long-term efficacy of thoracoscopy performed for diagnosis and management of pleural processes. Potential dangers, however, of thoracoscopy are acknowledged, and limitations of the procedure are addressed.

(CHEST 1995; 108:324-29)

Section snippets

Patients

Included in this study were all patients with pleural effusions of unknown etiology, suspected or proven empyema, or recurrent malignant pleural effusions requiring pleurodesis who were referred to the Pulmonary Special Procedures Unit of University of California San Diego Medical Center, San Diego, for thoracoscopy after less invasive means of diagnosis or therapy had failed.

Techniques

Procedures were usually performed in the operating room with patients under general anesthesia after intubation with a

Results

Fifty patients (34 men and 16 women) underwent 52 total procedures during a 15-month period. One patient had two consecutive ipsilateral procedures: the first for diagnosis and the second for pleurodesis. Another had bilateral procedures. Median age was 60 years (range, 18 to 88 years). Thoracoscopy was performed with the patient under general anesthesia with selective endobronchial intubation in 40 instances. General anesthesia with spontaneous ventilation was used in eight patients, and local

Discussion

Recognized for decades in Europe, thoracoscopy for diagnosis and management of pleural processes generally has been considered to be a safe procedure.6,7 Until the recent flurry of articles pertaining to video-assisted thoracic surgery,8, 9, 10 few investigations were specifically designed to determine the frequency of procedure-related complications. Of 102 patients undergoing thoracoscopy under local anesthesia, hemodynamic compromise or persistent air leak requiring thoracotomy was reported

ACKNOWLEDGMENTS

The author thanks Ken Moser and Tames Harrell for their constant support; Chris Lewis and Nancy Brewer for their help in data collection; and the Fellows of the University of California San Diego Pulmonary Division, San Diego, for their enthusiasm.

References (29)

  • DanielTM et al.

    Thoracoscopy and talc poudrage for pneumothoraces and effusions

    Ann Thorac Surg

    (1990)
  • RidleyPD et al.

    Thoracoscopic debridement and pleural irrigation in the management of empyema thoracis

    Ann Thorac Surg

    (1991)
  • AllenMS et al.

    Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules

    J Thorac Cardiovasc Surg

    (1993)
  • JanssenJP et al.

    Extended thoracoscopy: a biopsy method to be used in case of pleural adhesions

    Eur Respir J

    (1992)
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