Outcomes and complications following medical thoracoscopy Fraser John Hall Brims 1 , Mohammad Arif 2 and Anoop Jivan Chauhan 2 1 Department of Thoracic Medicine, University College London Hospital NHS Foundation Trust, London, UK 2 Respiratory Department, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK Abstract Introduction: Thoracoscopy is an invasive procedure that may be performed by physicians for the investigation of exudative pleural effusion using local anaesthe- sia, conscious sedation and a rigid thoracoscope. Objectives: We sought to evaluate the safety and outcome of thoracoscopy in Portsmouth Hospitals, UK, a dockyard city with high previous asbestos usage. Methods: Retrospective casenote, radiology and laboratory result analysis of patients undergoing thoracoscopy in our institution over a 12-month period. Results: Fifty-seven of 58 casenotes were available for analysis. Median (interquar- tile range) age was 73.0 (66.5–79.0) years and 44 (77.2%) were male. Median time with chest drain post-procedure was 3.0 (2.0–5.0) days, and length of stay (LOS) was 4.0 (2.0–8.0) days. Malignant histology was reported in 40 (70.2%), with 25 (62.5%) cases of mesothelioma. There were no deaths related to the procedure. Hospital-acquired infection (HAI) occurred in six (10.5%: pneumonia four, empyema two), all had malignancy. The presence of HAI significantly prolonged the LOS 9.0 (7.5–23.5) vs no HAI 4.0 (2.0–7.0) days; P = 0.006). Four patients died within 1 month of the procedure, three had a malignant diagnosis, all had suffered HAI. Trapped lung (persistent hydropneumothorax 5 days post-procedure) occurred in 11 (19.2%), six of whom had benign histology. Performance status (European Cooperative Oncology Group) prior did not differ with reported his- tological type: benign 2.0 (2.0–2.0), malignant 2.0 (2.0–3.0), P = 0.170. Conclusions: Serious complications following thoracoscopy are rare. HAI is asso- ciated with malignancy and prolonged hospital stay. Benign histology may still confer significant morbidity. Please cite this paper as: Brims FJH, Arif M and Chauhan AJ. Outcomes and complications following medical thoracoscopy. Clin Respir J 2012; 6: 144–149. Introduction The use of thoracoscopy for the diagnosis of pleural effusions was first described in 1910 by an internist from Stockholm called Hans-Christian Jacobaeus (1). In 1925 Jacobaeus then reported the use of rigid urology forceps to diagnose pleural tumour (2); since then little has changed with the techniques applied. A distinction has been made between ‘surgical’ and ‘medical’ thoracoscopy (3) with surgical, or video- assisted thoracoscopic surgery, being more invasive with multiple ports of entry and requiring a general anaesthetic and double lumen endotracheal tube. ‘Medical’ thoracoscopy can be performed by physi- cians under conscious sedation with local anaesthetic in an endoscopy suite, and as a result is less invasive and less expensive (4). Its popularity has varied in the past, but has enjoyed renewed interest from pulmonary physicians in the United Kingdom, Europe and United States over the recent years (5–7). Key words complications – outcomes – thoracoscopy Correspondence Fraser Brims, MRCP, MD, 4th Floor, Rockerfeller Building, 21 University Street, London WC1E 6JJ, UK. Tel: +44 (0) 207 288 3891 Fax: +44 (0) 207 380 9081 email: f.brims@ucl.ac.uk Received: 14 September 2010 Revision requested: 24 November 2010 Accepted: 28 November 2010 DOI:10.1111/j.1752-699X.2011.00254.x Authorship and contributorship FJB – Contributed to data collection, analysis and writing the paper. MA – Contributed to data collection. AJC – Contributed to data collection and writing the paper. Ethics This study has been performed in accordance with the ethical standards laid down in the Declaration of Helsinki and complied with National and local ethical standards of practice. Conflict of interest None of the authors have any conflicts of interest to declare. No financial or other potential conflicts of interest exist for any of the authors. Sources of financial support for this research: none. The Clinical Respiratory Journal ORIGINAL ARTICLE 144 The Clinical Respiratory Journal (2012) • ISSN 1752-6981 © 2011 Blackwell Publishing Ltd