Medical thoracoscopy. Role in pleural and lung diseases.

This overview of the indications for interventional thoracoscopy is far from exhaustive and new applications will surely be proposed. In conclusion, thoracoscopy provides diagnosis of pleural-based malignancy or tuberculosis with a high degree of accuracy when routine cytology and closed-needle pleural biopsies have failed. In patients in whom adequate visualization can be accomplished, an unequivocal pathologic diagnosis of benign disease can be made with a specificity approaching 100%. If transbronchial biopsy and bronchoalveolar lavage are inconclusive, VATS lung biopsy appears to be a safe alternative to open lung biopsy by thoracotomy for diagnosis of diffuse interstial or infectious lung disease. Thoracoscopy is often effective in the management of malignant pleural effusion and spontaneous pneumothorax. A close working relationship between pulmonary physicians and thoracic surgeons will assure that patients undergoing diagnostic thoracoscopy, under local anesthesia with intravenous sedation in the pulmonary endoscopy suite, are appropriate candidates for this procedure. It is absolutely mandatory that physicians intent on performing this procedure be adequately trained. We believe that collaboration between thoracic surgeons and pulmonologists not only facilitate training in thoracoscopy, but also insure that patients undergoing thoracoscopy will be carefully assessed from both perspectives.