Medical thoracoscopy: rigid thoracoscopy or flexi-rigid pleuroscopy?
OBJECTIVE
In managing pleural diseases, medical thoracoscopy is often performed as a diagnostic and/or therapeutic procedure, particularly in undiagnosed pleural effusions. Flexi-rigid pleuroscopes are now widely available as an alternative to conventional rigid thoracoscopes. There is an ongoing debate on which is the better instrument. This review analyses the current literature that compared rigid and flexi-rigid approaches, and outlines the medical advances that may influence the future role of thoracoscopy.


RESULTS
Both rigid and flexi-rigid thoracoscopies are well tolerated. Although biopsies are smaller with flexi-rigid biopsy forceps, two small randomized trials reported similar diagnostic yield using either instrument. No studies have specifically examined patient comfort or the outcome of talc poudrage using the two devices. New techniques (e.g. insulated-tip knife and cryobiopsy) have been used as adjuncts with flexi-rigid pleuroscopy to overcome the difficulties in sampling thickened pleura.


CONCLUSIONS
The rigid and flex-rigid instruments have different merits and limitations. Both approaches provide comparable diagnostic yields in the overall patient population undergoing diagnostic thoracoscopy, though their performances specifically in patients with fibrotic pleural thickening have not been examined. Operators using the flexi-rigid approach should have alternative strategies for sampling thickened pleura. Advances in cytopathology and imaging-guided biopsy will likely reduce the need of medical thoracoscopy in the future.
aDepartment of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia bDepartment of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore cCentre for Asthma, Allergy & Respiratory Research, School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
Kim Hoong
KH
Yap
Martin J
MJ
Phillips
Y C Gary
YC
Lee
D001706:Biopsy; D003937:Diagnosis, Differential; D004867:Equipment Design; D006801:Humans; D010996:Pleural Effusion / Q000175:diagnosis* / Q000473:pathology; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000295:instrumentation / Q000379:methods