[Thoracoscopy in 1980. A general review (author's transl)]

Abstract

Examining the literature and their own experience, the authors reviewed the methods, the complications and indications of modern thoracoscopy. They considered the rigid cold light thoracoscope with diathermo-coagulation. The authors stressed the importance of the macroscopic appearance of the pleural cavity, and the need to take numerous biopsies. Several types of anesthesia can be used, although the authors prefer general anesthesia for the comfort of both the patient and the doctor. Complications are very rare, the main ones being hemorrhage, pulmonary perforation and contamination of the puncture route with cancer cells. The first two can be avoided by good technique and diathermo-coagulation. The latter can be prevented by systematic radiotherapy of the puncture route, in mesothelioma patients. Amongst the numerous indications mentioned, three are important: the etiological diagnosis of chronic effusion, where cancer is a major fear. In these cases, the authors get 97% of positive results. Spontaneous pneumothorax is also a good indication: thoracoscopy allows a useful separation of patients, into those who need surgical treatment, or those in whom local adhesion of the pleura with talcum powder would be effective. Finally, pulmonary biopsy via the thoracoscope is a reliable and effective technique in a large number of indications.