A Less Invasive Approach to Thoracoscopy

Study objectives: To evaluate minithoracoscopy using 3-mm instrumentation for diagnosis of pleural effusions. In the initial phase of the study, minithoracoscopy was used only for small loculated effusions not accessible with standard-sized endoscopes. Indication was later extended to larger nonloculated effusions that could have been examined using conventional thoracoscopy. Patients: A total of 30 patients were studied, including 12 patients with nonloculated effusions of undetermined etiology, 17 patients with loculated effusions, and 1 patient with bilateral effusion. Technique: The double-entry site technique was used with placement of two trocars, ie, one for the telescope and one for the biopsy forceps or accessory instruments. All procedures were performed under local anesthesia with mild sedation (midazolam). Results: Minithorascopy provided high diagnostic yield (93.4%). Visualization using minithoracoscopy instrumentation was equal to that obtained using conventional thoracoscopy instrumentation. Tolerance and cosmetic results were good. Conclusions: Minithoracoscopy is safe and effective for routine diagnostic applications. (CHEST 2003; 124:1975–1977)