Introduction Medical thoracoscopy is an invasive procedure that may be performed by physicians for the investigation of exudative pleural effusion using local anesthesia, conscious sedation, and a rigid thoracoscope. Objective The aim was to evaluate the outcome of thoracoscopy in Abbassia Chest Hospital, Cairo. Patients and methods A retrospective study was conducted. The results of histopathological diagnosed was statistically analyzed. Results A total of 123 patients were available for analysis. Their mean age was 58.63 (22-80) years, and 64 (52%) were male. The mean duration of chest drain after procedure was 9.79 (3-41) days, and the duration of hospital stay was 24.54 (10-55) days. Malignant histology was reported in 108 (87.8%) patients, with 75 (61%) cases of mesothelioma. In 108 (87.8%) patients, pleurodesis was performed. The incidence of complications among the patients was 12.2% of all patients. The most common complications were blocked drain and empyema; other complications included subcutaneous emphysema, drain dislodgement, and bronchopleural fistula; and the least common complications were respiratory failure and atrial fibrillation. Conclusion Thoracoscopy is a minimally invasive procedure that allows visualization of the pleural space and intrathoracic structures. It enables taking pleural biopsies under direct vision, therapeutic drainage of effusions, and pleurodesis in one sitting.