Video-assisted thoracoscopic lung and pleural biopsy in the diagnosis of chronic pleural effusion

Chronic pleural effusion requires pleural and lung biopsy in more than 60% of patients. Open king biopsy was formerly considered as the most reliable diagnostic method, whereas now the Procedure is mostly performed via video-assisted thoracoscopy, During the last ten-year period (19952005), 96 patients aged 31-72 (mean age 53) years were operated on at University Department of Thoracic Surgery, Jordanovac University Hospital for Lung Diseases by video-assisced thoracoscopy in general anesthesia. All biopsies were done by clamp sampling from parietal or visceral pleura, and in 31 patients lung tissue was sampled by endostapler wedge resection. Conversion to mini-thoracotomy was needed in only 12 patients, due to massive adhesions. Tissue samples were referred for histopathologic analysis. After the procedure, the patients had a thoracic drain connected to negative pressure. Histopathologic diagnosis was made in almost all patients, yielding a 97% success rate. In 16 patients, drain airflow had to be prolonged to more than 5 days, while the mean drainage duration was 4 days and mean hospital stay 8 days. Tale pleurodesis was performed in most patients with malignant effusion to stop effusion accumulation. Video-assisted thoracoscopic biopsy allows for adequate pleural and lung sampling with a high rate of accuracy. Postoperative mortality and morbidity are lower in comparison with open lung biopsy It is concluded that video-assisted thoracoscopic biopsy is an efficient and safe method in the diagnosis of chronic pleural effusion.