Outcome of medical thoracoscopy.

BACKGROUND: Medical thoracoscopy is a common procedure for pulmonologists working in Europe but is still unpopular in South East Asia with few medical centers in Thailand performing this procedure. We report our outcome of medical thoracoscopy based upon 10 years experience.

MATERIAL AND METHOD: Medical thoracoscopy was first performed in our unit in 1998. The early indication was undiagnosed pleural effusion. Other indications which were empyema, pneumothorax and talc pleudrage were carried on for the last 3 years. The patients' demographic data, indication for medical thoracoscopy, procedures, complication and outcome were recorded and analyzed separately.

RESULTS: During 1998 to 2007, there were 142 procedures of medical pleuroscopy performed. There were 86 procedures for the indication of undiagnosed pleural effusion. The diagnostic yield was 95.2%. The malignancy was recovered by thoracoscopy in 45.35% of procedure. For indication of talc pleurodesis, there were 22 patients with 3 who had early failure of pleurodesis because of trapped lung. After mean follow up of 124 days, 17 patients did not have recurrence of pleural effusion. 15 patients who had loculated pleural effusion were done medical thoracoscopy. Operations were successful in only 6 patients. For indication of pneumothorax 5 out of 6 procedures were successful after mean follow up of 167 days. In 12 empyema patients, mean hospital admission was 9.1 days after thoracoscopy. There was no serious complication from the procedure.

DISCUSSION: There are many indications for medical thoracoscopy and the experience of the performer is the important factor determining success of the procedure. In undiagnosed pleural effusion, our result was comparable to other studies in the past in which the rate of malignancy was around 40-60%. The result of talc pleudrage was also comparable with the need to improve the diagnosis of trapped lung to prevent the unnecessary medical thoracoscopy. The result was excellent in patients who came for pleurodesis indicated in pneumothorax also in empyema but number of patient was still low. The problem was in loculated pleural effusion from malignancy which showed high failure rate. The early pleurodesis in malignant pleural effusion before it became loculated should be considered.

CONCLUSION: Outcome of medical thoracoscopy varies from various indications. The success rate was high and decreasing in undiagnosed pleural effusion, pneumothorax, empyema and talc pleurodesis in malignant effusion. Great skill was needed to perform medical thoracoscopy in loculated malignant pleural effusion