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Redo medical thoracoscopy is feasible in patients with pleural diseases – a series

^a Division of Thoracic Oncology, Department of Pulmonary Diseases, Faculty of Medicine (Université de la Méditerranée), Assistance Publique Hôpitaux de Marseille, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 09, France
^b Department of Respiratory Medicine, CResT Directorate, St. James's Hospital, Dublin 8, Ireland
^c Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK

*Corresponding author. Tel.: +33 (0) 491 744 736; fax: +33 (0) 491 745 524.

E-mail address: pastoul{at}ap-hm.fr (P. Astoul).

Previous pleural endoscopy is considered to be a relative contraindication to further medical thoracoscopy. We reviewed our experience in patients undergoing more than one thoracoscopy irrespective of the primary indication. From January 2001 to December 2006, patient baseline characteristics, endoscopic appearance and technique, volume of pleural fluid and final histological diagnosis were collated in all patients undergoing more than one thoracoscopy. The endpoints were morbidity and mortality related to the procedures, to compare the length of procedure time between pleural endoscopies in individual patients and the degree of difficulty of the second or subsequent thoracoscopic procedure. During this period, 29 patients underwent ‘redo’ thoracoscopy resulting in a total of 61 procedures (rate of ‘redo’ thoracoscopy; 9.1%). The mean time between thoracoscopies was 5.3±3.8 months. Although pleural adhesions were more common at the time of the subsequent procedure, it did not result in failure to induce a pneumothorax or perform the procedure. There was no difference in the duration of procedure between the primary and subsequent thoracoscopy (P=0.46), as well as no complications directly attributed to the repeat pleural endoscopy. Repeat medical thoracoscopy is technically feasible in patients with pleural disease without an associated increased morbidity and mortality.

Key Words: Thoracoscopy; Second look; Pleural mesothelioma; Pleural effusion