Videothoracoscopy in Pleural Effusions: A Review of 41 Cases

Abstract

This study aimed to evaluate the diagnostic and therapeutic value of videothoracoscopy in patients with pleural effusion. A total of 41 patients underwent video-assisted thoracic surgery (VATS) were analyzed, 25 male and 16 female. The mean age was 52.1 years (ranged between 18 and 92 years). Pleural effusion was left sided in 19 cases (46.4%), right sided in 14 cases (34.1%) and bilateral in eight cases (19.5%). Subjects with exudative and hemorrhagic pleural effusions in thoracentesis were included in the study. In all cases; complete blood count, electrocardiography (ECG), arterial blood gas, coagulation profile and respiratory function test (RFT) were performed. Two view chest X-ray and computed tomography scans were done to determine the localization of fluid and to decide the access point to thorax prior to procedure. One-lung ventilation was achieved in 20 patients under general anestesia, whereas double lung ventilation was preferred in 13 cases intolerant of one-lung ventilation. The procedure was carried out under local anesthesia in eight cases due to their high risk for general anesthesia. An approximately 50cc of pleural fluid and at least two pieces of pleural biopsy specimen for cytopathological examination were collected in all cases. Among the study population, 33 of cases were diagnosed with a benign disease and the remaining eight cases with a malign disease. Taking age ranges into account, non-specific pleuritis and tuberculosis pleuritis were most commonly diagnosed between 20 to 40 years of age whereas malign pathologies between 40-60 years of age. Diagnostic success of the procedure was found to be 97.6%. Patients with malign effusion underwent chemical pleurodesis with talc powder. No complication developed in our cases. VATS seems to be an effective method in the diagnosis and treatment of patients with pleural effusion. © 2013 OMU.