Role for Video-Assisted Thoracoscopy in Undiagnosed Pleural Effusion: An Audit to Represent our Clinical Experience?

Document Type : Original Article


Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Egypt



Background: Undiagnosed pleural effusion represents a health challenge. To discover possible causes, there were a number of invasive and non-invasive modalities. Each modality had its own accuracy.
The aim of the work: The current work aimed to evaluate the role of video-assisted thoracoscopy (VATS) in the undiagnosed intermediate pleural effusion.
Materials and Methods: The current work included forty patients with undiagnosed intermediate pleural effusion. All underwent preoperative assessment [history, physical examination, laboratory and radiological investigation]. Then, all submitted to VATS, pleurocentesis had been completed, and pleural aspirates were sent for culture and sensitivity. Also, the aspirate was subjected to biochemical investigation]. Operative data related to VATS included time of the whole procedure, intraoperative complications, amount of drained pleural fluid, the ability to obtain multiple biopsies, field exposure and degree of lung expansion. The visual analogue scale [VAS] was used to assess postoperative pain. Any postoperative complications were documented.
Results: The mean operative time was 54.37±7.63 minutes, and no intraoperative complications had been recorded. The field exposure was adequate among the majority (77.5%). The VATS was able to provide a diagnosis for all studied patients. The mean duration of hospital stay was 5.90±1.53 days; the mean chest tube duration was 5.65±1.27 days. Finally, recurrent effusion was reported in 7 patients (17.5%) (5 males and two females). All patients need postoperative analgesia with great variability and postoperative pain showed significant variance across time (during the first 24 hours). 60% need no further intervention, while 32.5% need pleurodesis, and 7.5% need decortication. Malignant effusion was reported in 9 patients (22.5%).
Conclusions: VATS as a diagnostic and therapeutic tool for undiagnosed pleural effusions, is an effective and safe intervention. Thus, it is advocated to be used as the standard and first intervention in such patients.