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Ultrasound effectively guides surgeons during medical thoracoscopy

The use of ultrasonography helped experienced surgeons identify intrathoracic adhesions and guided medical thoracoscopy access even when pleural effusion was absent, according to study results.

“Lesions of the pleura in absence of pleural effusion are usually studied with video-assisted thoracoscopic surgery (VATS) in the operating room, under general anesthesia and one-lung ventilation,” Giampietro Marchetti, MD, of Spedali Civili di Brescia in Italy, and colleagues wrote. “Our data have shown that in selected cases, even in the absence of pleural effusion and where the sliding sign is evident, it is possible to perform pleuroscopy safely in the endoscopic room, under conscious sedation and in spontaneously breathing patients.”

From January 2007 to June 2013, the researchers conducted 622 consecutive medical thoracoscopies (MTs) without inducing a pneumothorax. The researchers then conducted a retrospective cohort study of 29 patients affected by pleural diseases without fluid and in whom chest ultrasonography showed the presence of a sliding sign.

The researchers reported no parenchymal lung injuries during pleuroscopy, and no bleeding or hematoma on the surface of the lung “in relationship to the entry site.” In conducting MTs, the researchers detected 13 cases of malignant mesothelioma, four metastatic bronchogenic carcinomas, and five other tumors.

Pleural adhesions are the primary concern when performing pleuroscopy, the researchers wrote, because lung collapse may prevent access to the pleural space, resulting in possible injury.

“The increasing use of ultrasound in MT in the last 20 years has permitted the operator to avoid the induction of a pneumothorax, saving time and reducing the radiation exposure of the patients,” the researchers wrote.