Document Detail


Feasibility and Safety of Outpatient Medical Thoracoscopy at a Large Tertiary Medical Center: A Collaborative Medical-Surgical Initiative.
MedLine Citation:
PMID:  24577099     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT BACKGROUND: Medical thoracoscopy (MT) is performed by relatively few pulmonologists in the United States. Recognizing that an outpatient minimally invasive procedure such as MT could provide a suitable alternative to hospitalization and surgery in patients with undiagnosed exudative pleural effusions, we initiated the Mayo Clinic outpatient MT program, and herein report preliminary data on safety, feasibility, and outcomes.
METHODS: All consecutive patients referred for outpatient MT from October 2011 to August 2013 were included in this study. Demographic, radiographic, procedural, and histologic data were prospectively recorded and subsequently analyzed.
RESULTS: Outpatient MT was performed on 51 patients with the most common indication being an undiagnosed exudative effusion in 86.3% of our cohort. Endoscopic findings included diffuse parietal pleural inflammation in 26 (51%) patients, parietal pleural studding in 19 (37.3%), a normal exam in 3 (5.9%), diffuse parietal pleural thickening in 2 (3.9%), and a diaphragmatic defect in 1 (2%). Pleural malignancy was the most common histologic diagnosis in 24 (47.1%) patients and comprised predominantly of mesothelioma in 14 (27.5%). Non-specific pleuritis was the second most frequent diagnosis in 23 (45.1%) patients. There were very few complications with no significant cases of hemodynamic or respiratory compromise and no deaths.
CONCLUSIONS: Outpatient MT can be successfully integrated into a busy tertiary referral medical center through the combined efforts of interventional pulmonologists and thoracic surgeons. Outpatient MT may provide patients a more convenient alternative to an inpatient surgical approach in the diagnosis of undiagnosed exudative pleural effusions while maintaining a high diagnostic yield and excellent safety.
Authors:
Zachary S Depew; Dennis Wigle; John J Mullon; Francis C Nichols; Claude Deschamps; Fabien Maldonado
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-27
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-2-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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