What is the key question?

• Definitive diagnosis of pleural effusion can be problematic. Many effusions remain undiagnosed despite repeated thoracentesis and pleural biopsy. Each time a procedure is performed the risk of adverse events increases.

What is the bottom line?

• Thoracoscopy/ pleuroscopy and VATs are both used to assist in diagnosing and treating malignant effusions in particular and have similar yield (around 90%).
• There may be some advantage to using thoracoscopy with sedation (awake thoracoscopy:AT) as opposed to VATS with general anaesthesia and single lung ventilation, particularly in those with significant pulmonary and cardiac co-morbidities, a common feature of patients with effusion.
• The authors sought to retrospectively determine whether the efficacy, safety and cost of thoracoscopy compared favourably to VATS for undiagnosed pleural effusion.
  

Why read on?

• There was no difference in diagnostic yield or major and minor complication rates between AT and VATS. Hospital length of stay, time to removal of ICC and total cost were greater with VATs than AT.
• The authors conclude that AT has similar diagnostic yield and safety profile to VATS in pleural effusion but that AT has a shorter length of stay and lower cost.