Abstract
OBJECTIVE: We present our experience of extended indications of local anaesthesia thoracoscopy.MATERIALS AND METHODS: 110 patients who underwent local anaesthesia thoracoscopy for undiagnosed pleural effusions over a one year period (since july2013 to june 2014) were analysed in retrospect.Local anaesthesia thoracoscopy was carried out by a three - level intercostal blockade local anaesthesia and a rigid thoracoscope. Sedation was with intravenous dexmetedomidine infusion.RESULTS: Of the 110 patients, 74% were male and 26% were females. Of the pleural biopsies, 37 (46%) patients had benign pleural disease ( 24 non-specific inflammation, 9 tubercular and 3 eosinophilic inflammation). 43 (54%) patients had malignant pleural disease ( 24 metastatic lung cancer, 7 malignant mesothelioma, 12 metastatic from other sites). In addition to diagnostic pleural biopsy, we present the following extended indications : 15 underwent pleurodesis, 2 lung biopsy, 7 breakdown of multiloculated empyema and empyema culture, 1 removal of foreign body (seldinger wire),1 phrenic nerve crush, 2 pericardial biopsy. The extended indications was done along with thoracic surgical support.The commonest complication was subcutaneous emphysema in 15 patients ( 13.6%). All patients had positive histology.CONCLUSION: Local anaesthesia thoracoscopy (medical thoracoscopy) is widely used for pleural biopsy, fluid drainage and pleurodesis; this technique can also be used for numerous extended indications as demonstrated above, facilitated by thoracic surgical support.