PT  - JOURNAL ARTICLE
AU  - G. F. Tassi
AU  - R. J. O. Davies
AU  - M. Noppen
TI  - Advanced techniques in medical thoracoscopy
AID  - 10.1183/09031936.00014106
DP  - 2006 Nov 01
TA  - European Respiratory Journal
PG  - 1051--1059
VI  - 28
IP  - 5
4099  - http://erj.ersjournals.com/content/28/5/1051.short
4100  - http://erj.ersjournals.com/content/28/5/1051.full
SO  - Eur Respir J2006 Nov 01; 28
AB  - For expert pulmonologists, advanced procedures in medical thoracoscopy are the nonroutine and more complex applications of the method. The main current indications are the treatment of infected pleural space, forceps lung biopsy and sympathectomy. In parapneumonic effusions and empyema, medical thoracoscopy is as a drainage procedure, intermediate between tube thoracostomy and video-assisted thoracoscopic surgery (VATS), which is efficient, significantly lower in cost and avoids surgical thoracoscopy under general anaesthesia. It is essential that it is performed early in the course of the disease and is particularly advisable for frail patients at high surgical risk. The efficacy of forceps lung biopsy has been demonstrated in diffuse lung diseases, whereas results in localised lung diseases and chest-wall lesions have been less positive. However, VATS is currently the preferred approach for these indications. The technique still maintains its efficacy for visceral pleura and peripheral lung biopsy, in particular in the presence of pleural effusion and lung disorders. At the present time, thoracoscopic sympathectomy is minimally invasive and is an accepted intervention for patients with a variety of autonomous nervous system disturbances. Essential hyperhidrosis patients, and well-selected patients with other disorders, can be helped with this procedure, which can also be performed by interventional pulmonologists. SERIES “INTERVENTIONAL PULMONOLOGY” Edited by J.P. Janssen, M. Noppen and K.F. Rabe Number 5 in this Series