Safety and Complications of Medical Thoracoscopy

Our plain-English summary of Safety and Complications of Medical Thoracoscopy, by S. Nour Moursi Ahmed, H. Saka, H.A. Mohammadien, et al (Advances in Medicine, 2016).

The study

• Authors: S. Nour Moursi Ahmed, H. Saka, H.A. Mohammadien, O. Alkady, M. Oki, Y. Tanikawa, R. Tsuboi, M. Aoyama, K. Sugiyama
• Journal: Advances in Medicine
• Published: 2016;2016:3794791
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives. To highlight the possible complications of medical thoracoscopy (MT) and how to avoid them. Methods. A retrospective and prospective analysis of 127 patients undergoing MT in Nagoya Medical Center (NMC) and Toyota Kosei Hospital. The data about complications was obtained from the patients, notes on the computer system, and radiographs. Results. The median age was 71.0 (range, 33.0-92.0) years and 101 (79.5%) were males. The median time with chest drain after procedure was 7.0 (range, 0.0-47.0) days and cases with talc poudrage were 30 (23.6%). Malignant histology was reported in 69 (54.3%), including primary lung cancer in 35 (27.5), mesothelioma in 18 (14.2), and metastasis in 16 (12.6). 58 (45.7%) revealed benign pleural diseases and TB was diagnosed in 15 (11.8%). 21 (16.5%) patients suffered from complications including lung laceration in 3 (2.4%), fever in 5 (3.9%) (due to hospital acquired infection (HAI) in 2, talc poudrage in 2, and malignancy in 1), HAI in 2 (1.6%), prolonged air-leak in 14 (11.0%), and subcutaneous emphysema in 1 (0.8%). Conclusions. MT is generally a safe procedure. Lung laceration is the most serious complication and should be managed well. HAI is of low risk and can be controlled by medical treatment.

In plain English

This study looked at the safety of medical thoracoscopy. In this procedure a doctor passes a camera into the chest to examine the lining around the lungs (the pleura) and take biopsies. The authors reviewed past records and also followed later patients forward, 127 in all, treated at Nagoya Medical Center (2007 to 2015) and Toyota Kosei Hospital (2011 to 2015) in Japan. The study did not examine asbestos exposure. The procedure found cancer in 69 patients (54.3%), including mesothelioma in 18 (14.2%), and benign disease in 58 (45.7%). Complications occurred in 21 of the 127 patients (16.5%). The most common was prolonged air leak, in 14 (11.0%). Fever occurred in 5 (3.9%), hospital-acquired infection in 2 (1.6%), a tear in the lung (lung laceration) in 3 (2.4%), and air under the skin (subcutaneous emphysema) in 1 (0.8%). No death was attributed to the procedure, although one patient with hospital-acquired infection developed septicemia and died. The authors concluded that medical thoracoscopy is generally a safe procedure and that lung laceration is the most serious complication.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective and prospective case series analysis of patients undergoing medical thoracoscopy
• Who was studied: 127 patients (median age 71.0 years, range 33.0 to 92.0; 101 male) who underwent medical thoracoscopy at Nagoya Medical Center, Japan (2007 to 2015) and Toyota Kosei Hospital, Japan (2011 to 2015). Of 139 patients, 10 were excluded for missing data and 2 for failure to complete the procedure.
• Exposure: Not an asbestos exposure study. The intervention studied was medical thoracoscopy with pleural biopsy. Some patients also received talc poudrage (4 g of graded talc) for pleurodesis: 30 patients (23.6%).
• Main results:
  • Malignant histology in 69 of 127 patients (54.3%), including mesothelioma in 18 (14.2%), primary lung cancer in 35 (27.5%) and metastasis to the pleura in 16 (12.6%)
  • Mesothelioma was diagnosed in 18 patients (14.2%)
  • Benign pleural disease in 58 patients (45.7%), including tuberculosis in 15 (11.8%)
  • Complications occurred in 21 of 127 patients (16.5%)
  • Lung laceration in 3 patients (2.4%) and fever in 5 (3.9%). The fevers were due to hospital-acquired infection in 2, talc poudrage in 2 and malignancy in 1.
  • Prolonged air leak in 14 patients (11.0%), the most frequent complication
  • All 3 lung lacerations occurred while the trocar was being introduced and were no more than 1.5 cm long
  • No death was attributed to the procedure. 11 patients died of causes the authors judged unrelated to it, mainly malignancy and other illnesses.
  • Median duration of chest tube drainage after the procedure was 7.0 days (range 0.0 to 47.0)
• The authors' conclusion: The authors concluded that medical thoracoscopy is generally a safe procedure, that lung laceration is the most serious complication and should be managed well, and that hospital-acquired infection is of low risk and can be controlled by medical treatment.

Topics

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Talc, Histology, Lung Cancer, Mesothelioma, Metastasis, Emphysema.

Related studies

• The safety of medical thoracoscopy in a group at high risk for complications — M. Metintas, G. Ak, et al. (2013)
• Medical thoracoscopy, results and complications in 146 patients: a retrospective study — M. Hansen, P. Faurschou, et al. (1998)
• Outcomes and complications following medical thoracoscopy — F.J. Brims, M. Arif, et al. (2012)
• Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative — Z.S. DePew, D. Wigle, et al. (2014)
• Diagnostic performance and safety of image-guided pleural biopsy and medical thoracoscopy for undiagnosed exudative pleural effusion: a systematic review and network meta-analysis — S. Lyu, Z. Zheng, et al. (2026)
• Sensitivity and complications of thoracentesis and thoracoscopy: a meta-analysis — G. Martinez-Zayas, S. Molina, et al. (2022)

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