Medical thoracoscopy in the diagnosis and treatment of lung/pleural disease: Sharing an experience of 1125 cases

Introduction: MT has substantially thrived over the last decade and has been a useful technique in the hands of experienced chest physicians. Objective: To assess our 12-year experience(2000-2012)of our first 1125 MT cases in terms of clinical efficacy/patient outcome. Materials and methods: Retrospective review of 1125 MT patients&clinical follow up at 1, 6 and 12 months post procedure.We assessed diagnostic efficacy,sensitivity,complications,recurrences,survival,clinical effectiveness(SPSS v12.0). Results: Patients were 757 males and 368 females(mean age 69.7 years). 137/1125 had high risk comorbidities steming them from more invasive procedures.All MTs were performed in the endoscopy suite under conscious sedation(midazolam, fentanyl)and intercostal block(ropivacain)to diagnose+/-treat lung/pleural diseases.Mean hospital stay: 2.1 days(range 0-4) for diagnostic and 3.4 days(range 1-15) for therapeutic MT.The procedures were pleural biopsy 276/1125,talc pleurodesis 383/1125,pleural biopsy&talc pleurodesis 125/1125,lung biopsy(stappler device) 52/1125,empyema 264/1125, haemothorax 25/1125.Diagnosis was obtained in 95% patients, palliation in 65%, clinical effictiveness with no recurrency at 12 months in 84%. Sensitivity:88% for pleural and 99% for lung biopsies.Mortality:0.088%.No intraoperative or postoperative complications were recorded. Conclusions: The assessment of our first 1125 MT showed increased sensitivity,diagnostic and clinical efficacy with minimal hospital stay and morbidity.MT has been also safe and efficient in patients unable to undergo more invasive procedures.MT can be a useful tool in the hands of a skilled thoracic team ensuring optimal patient outcome.