Pleuroscopy in the preoperative staging of bronchial cancer

: The use of pleuroscopy or thoracoscopy in preoperative staging and resectability assessment of lung cancer is uncommon. Diagnostic and exploratory thoracoscopy could be helpful in three circumstances: when malignant pleural effusion is suspected with a lung cancer, while all the initial investigations remain negative: (cytology, needle-biopsy); in cases with radiological images (using CTs-can or MRI) of small metastatic pleural masses without effusion: thoracoscopy is performed after creating a pneumothorax; when mediastinal or hilar extension of the tumor and lymph-nodes (especially in the left superior mediastinum) cannot be reached for biopsy by mediastinoscopy or parasternal mediastinotomy. The investigation is performed under general anesthesia using double-lumen selective intubation and lung exclusion. This procedure provides a better view of the pleural space and mediastinal and hilar areas; macroscopic involvement of vital structures, organs or vessels can be easily seen and large biopsy specimens safely taken, without any postoperative morbidity. Talc insufflation for pleurodesis is added in patients with massive pleural effusion. Failures of the method or false-negative biopsies are related to previous pleurodesis, pleural partition, or adhesions. The contribution of CT scan and MRI imaging is mandatory to determine indications and to select the best endoscopic approach.