Semin Respir Crit Care Med 2019; 40(03): 410-416
DOI: 10.1055/s-0039-1694034
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Advances and Controversies in Thoracentesis and Medical Thoracoscopy

Jonathan Puchalski
1   Department of Medicine, Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations
Further Information

Publication History

Publication Date:
16 September 2019 (online)

Abstract

Pleural effusions are common and associated with high morbidity and mortality. Whereas thoracentesis can assist in achieving a diagnosis or therapy, advances in education and in the technique may prevent morbidity associated with the procedure. Medical thoracoscopy is often useful for undiagnosed effusions, as well as for therapeutic purposes. There is much enthusiasm about techniques for biopsies that extend beyond forceps. These include biopsies using a diathermic knife as well as cryoprobes. Similarly, adhesiolysis or other techniques to improve therapy in multiloculated effusions using medical thoracoscopy are contested. This review attempts to synthesize recent advances and controversies in thoracentesis and medical thoracoscopy as clinicians head into the next decade of treatment.

 
  • References

  • 1 Feller-Kopman D, Light R. Pleural disease. N Engl J Med 2018; 378 (18) 740-751
  • 2 Owings MF, Kozak LJ. Ambulatory and inpatient procedures in the United States, 1996. Vital Health Stat 13 1998; (139) 1-119
  • 3 DeBiasi EM, Puchalski J. Thoracentesis: state-of-the-art in procedural safety, patient outcomes, and physiologic impact. Pleura (Thousand Oaks) 2016; 3: 1-10
  • 4 Barsuk JH, Cohen ER, Williams MV. , et al. Simulation-based mastery learning for thoracentesis skills improves patient outcomes: a randomized trial. Acad Med 2018; 93 (05) 729-735
  • 5 Nakawala H, Ferrigno G, De Momi E. Development of an intelligent surgical training system for thoracentesis. Artif Intell Med 2018; 84: 50-63
  • 6 Rasmussen KMB, Hertz P, Laursen CB. , et al. Ensuring basic competence in thoracentesis. Respiration 2019; 97 (05) 463-471
  • 7 Williamson JP, Twaddell SH, Lee YC. , et al. Thoracic ultrasound recognition of competence: a position paper of the Thoracic Society of Australia and New Zealand. Respirology 2017; 22 (02) 405-408
  • 8 Salamonsen MR, Bashirzadeh F, Ritchie AJ, Ward HE, Fielding DI. A new instrument to assess physician skill at chest tube insertion: the TUBE-iCOMPT. Thorax 2015; 70 (02) 186-188
  • 9 Senitko M, Ray AS, Murphy TE. , et al. Safety and tolerability of vacuum versus manual drainage during thoracentesis: a randomized trial. J Bronchology Interv Pulmonol 2019; 26 (03) 166-171
  • 10 Kim H, Shyn PB, Wu L, Levesque VM, Khorasani R, Silverman SG. Wall suction-assisted image-guided thoracentesis: a safe alternative to evacuated bottles. Clin Radiol 2017; 72 (10) 898.e1-898.e5
  • 11 Lentz RJ, Lerner AD, Pannu JK. , et al. Routine monitoring with pleural manometry during therapeutic large-volume thoracentesis to prevent pleural-pressure-related complications: a multicentre, single-blind randomised controlled trial. Lancet Respir Med 2019; 7 (05) 447-455
  • 12 Puchalski J. Thoracentesis and the risks for bleeding: a new era. Curr Opin Pulm Med 2014; 20 (04) 377-384
  • 13 Cantey EP, Walter JM, Corbridge T, Barsuk JH. Complications of thoracentesis: incidence, risk factors, and strategies for prevention. Curr Opin Pulm Med 2016; 22 (04) 378-385
  • 14 Orlandi E, Citterio C, Seghini P, Di Nunzio C, Mordenti P, Cavanna L. Thoracentesis in advanced cancer patients with severe thrombocytopenia: ultrasound guide improves safety and reduces bleeding risk. Clin Respir J 2018; 12 (04) 1747-1752
  • 15 Linder K, Epelbaum O. Percutaneous pleural drainage in patients taking clopidogrel: real danger or phantom fear?. J Thorac Dis 2018; 10 (08) 5162-5169
  • 16 Lee P, Folch E. Thoracoscopy: advances and increasing role for interventional pulmonologists. Semin Respir Crit Care Med 2018; 39 (06) 693-703
  • 17 Sasada S, Kawahara K, Kusunoki Y. , et al. A new electrocautery pleural biopsy technique using an insulated-tip diathermic knife during semirigid pleuroscopy. Surg Endosc 2009; 23 (08) 1901-1907
  • 18 Wang XB, Yin Y, Miao Y. , et al. Flex-rigid pleuroscopic biopsy with the SB knife Jr is a novel technique for diagnosis of malignant or benign fibrothorax. J Thorac Dis 2016; 8 (11) E1555-E1559
  • 19 Yin Y, Eberhardt R, Wang XB. , et al. Semi-rigid thoracoscopic punch biopsy using a hybrid knife with a high-pressure water jet for the diagnosis of pleural effusions. Respiration 2016; 92 (03) 192-196
  • 20 Rozman A, Camlek L, Marc Malovrh M, Kern I, Schönfeld N. Feasibility and safety of parietal pleural cryobiopsy during semi-rigid thoracoscopy. Clin Respir J 2016; 10 (05) 574-578
  • 21 Thomas R, Karunarathne S, Jennings B. , et al. Pleuroscopic cryoprobe biopsies of the pleura: a feasibility and safety study. Respirology 2015; 20 (02) 327-332
  • 22 Pathak V, Shepherd RW, Hussein E, Malhotra R. Safety and feasibility of pleural cryobiopsy compared to forceps biopsy during semi-rigid pleuroscopy. Hai 2017; 195 (03) 371-375
  • 23 Tousheed SZ, Manjunath PH, Chandrasekar S. , et al. Cryobiopsy of the pleura: an improved diagnostic tool. J Bronchology Interv Pulmonol 2018; 25 (01) 37-41
  • 24 Wurps H, Schönfeld N, Bauer TT. , et al. Intra-patient comparison of parietal pleural biopsies by rigid forceps, flexible forceps and cryoprobe obtained during medical thoracoscopy: a prospective series of 80 cases with pleural effusion. BMC Pulm Med 2016; 16 (01) 98 . doi:10.1186/s12890-016-0258-5
  • 25 Chen CH, Cheng WC, Wu BR. , et al. Feasibility and safety of pleuroscopic cryobiopsy of the pleura: a prospective study. Can Respir J 2018; 2018: 6746470
  • 26 Dhooria S, Bal A, Sehgal IS. , et al. Pleural cryobiopsy versus flexible forceps biopsy in subjects with undiagnosed exudative pleural effusions undergoing semirigid thoracoscopy: a crossover randomized trial (COFFEE Trial). Respiration 2019; 98 (02) 1-9
  • 27 Shaw JA, Irusen EM, Diacon AH, Koegelenberg CF. Pleural tuberculosis: A concise clinical review. Clin Respir J 2018; 12 (05) 1779-1786
  • 28 Wang Z, Xu LL, Wu YB. , et al. Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion. Respir Med 2015; 109 (09) 1188-1192
  • 29 Casalini AG, Mori PA, Majori M. , et al. Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy. ERJ Open Res 2018 4. (01): doi: 10.1183/23120541.00046-2017
  • 30 Zhao T, Xu Y, Song Q, Wang X, Jin M, Lin D. Medical thoracoscopy for tuberculous pleurisy: a retrospective analysis of 575 cases. Ann Thorac Med 2019; 14 (02) 134-140
  • 31 Christopher DJ, Dinakaran S, Gupta R, James P, Isaac B, Thangakunam B. Thoracoscopic pleural biopsy improves yield of Xpert MTB/RIF for diagnosis of pleural tuberculosis. Respirology 2018; 23 (07) 714-717
  • 32 Shu Z, Weigel KM, Soelberg SD. , et al. Cryopreservation of Mycobacterium tuberculosis complex cells. J Clin Microbiol 2012; 50 (11) 3575-3580
  • 33 Xiong Y, Gao X, Zhu H, Ding C, Wang J. Role of medical thoracoscopy in the treatment of tuberculous pleural effusion. J Thorac Dis 2016; 8 (01) 52-60
  • 34 Ravaglia C, Gurioli C, Tomassetti S. , et al. Is medical thoracoscopy efficient in the management of multiloculated and organized thoracic empyema?. Respiration 2012; 84 (03) 219-224
  • 35 Brutsche MH, Tassi GF, Györik S. , et al. Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy. Chest 2005; 128 (05) 3303-3309
  • 36 Sumalani KK, Rizvi NA, Asghar A. Role of medical thoracoscopy in the management of multiloculated empyema. BMC Pulm Med 2018; 18 (01) 179 . doi: 10.1186/s12890-018-0745-y
  • 37 Anevlavis S, Froudarakis ME. Advances in pleuroscopy. Clin Respir J 2018; 12 (03) 839-847