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Thoracoscopy was improved after the introduction of video-surgery at the end of the 80s, enabling thorough investigation of the pleural cavity. However, the video-assisted thoracic surgery (VATS), requires general anesthesia, which limits its use in seriously ill patients and elderly patients. Closed pleural biopsy and analysis of pleural fluid by thoracocentesis have limited value in the diagnosis of pleural conditions. Thus, we studied the indications and the results of this procedure under local anesthesia in an elderly population and with borderline clinical condition.
Between 2003-2010, 137 thoracoscopies with local anesthesia and sedation were performed.
73 patients (53.2%) were female and 64 (46.8%) were male. The average age was 67 years. 91 patients (66.4%) had comorbidities, such as cardiac and renal failure, hypertension, diabetes and chronic obstructive pulmonary disease.
The indication of thoracoscopy was given by the following reasons: 6 patients with pleural empyema (4.3%); 7 hemothorax patients (5.1%); 49 patients (35%) with a history of malignancy and suspected secondary pleural effusion; 75 patients (54.7%) with pleural effusion of unknown cause.
In patients with neoplastic history (49 patients), the secondary pleural disease was confirmed in 71.4%. In 14 patients, pleural infiltration was not diagnosed. In 38 patients (86.3%), pleurodesis was performed due to a history of cancer and recurrence of pleural effusion. Talc was the only sclerosing agent used in all cases of pleurodesis. There was no immediate mortality related to the procedure nor need for thoracotomy due to bleeding after pleura and lung biopsies.
ConclusionThoracoscopy under local anesthesia is a low-cost method, technically simple and useful in the diagnosis and treatment of several pleural diseases. In critically ill, elderly and patients with several comorbidities, it should be considered as an alternative to VATS
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