Thoracoscopy for the evaluation and treatment of pleural space disease.

Pleural disease provided the first and, for many years, the only indication for thoracoscopy. It remains the most efficient way of obtaining a diagnosis in cases of pleural effusions not diagnosed by thoracentesis and closed-needle biopsy, especially when malignancy is suspected. Thoracoscopy also can provide enough tissue to define cell type. In malignant mesothelioma, it can help assess the resectability of the tumor. In cases of metastatic disease or inoperable malignant mesothelioma, treatment of the effusion by talc poudrage can be combined with a diagnostic procedure. Any case of empyema in which a chest tube does not result in defervescence or complete evacuation of the pleural fluid within 2 to 3 days should be considered for thoracoscopy. In early empyemas, adhesions and loculatons can be addressed, the infected material removed, and the cavity irrigated. If the lung then fully expands, the tubes may be removed when the drainage ceases, precluding the prolonged retention of empyema tubes. Thoracoscopy also has proved useful in the management of benign pleural tumors, hemothorax, and chylothorax.