Rigid vs. Flexi-rigid Pleuroscopy: Safety
Medical thoracoscopy, either by rigid or by flexi-rigid instruments, is a well tolerated procedure in experienced hands. The combined mortality rate from 47 studies was 0.34% (95% confidence interval, CI 0.19–0.54%). In the three recent comparative trials, no procedure-related death was reported.[9,19,20] The pooled rate of major adverse events was 1.8% (95% CI 1.4–2.2%). These include empyema, severe bleeding, port site metastasis, persistent air leak and pneumonia. Rozman et al. found that one (2.6%) patient developed severe bleeding after pleural biopsy during rigid thoracoscopy, whereas another (2.4%) developed empyema 1 week after flexi-rigid pleuroscopy with pleurodesis. Both patients recovered with treatment.
Dhooria et al. found no case of significant bleeding, but three cases (3 of 47, 6.4%) of empyema or persistent air leak from the rigid thoracoscopy arm and one case (1 of 35, 2.9%) from the flexi-rigid pleuroscopy arm. They attributed the higher rate of empyema and persistent air leak to extensive adhesiolysis for complicated parapneumonic effusions. The pooled incidence of minor complications was 7.3% (95% CI 6.3–8.4%), including pyrexia, subcutaneous emphysema, skin infection and minor hemorrhage.
In terms of periprocedural pain, larger trocars used during rigid thoracoscopy can cause greater discomfort. The requirement for sedative and analgesics was higher with rigid thoracoscopy in the study by Dhooria et al..
Curr Opin Pulm Med. 2014;20(4):358-365. © 2014 Lippincott Williams & Wilkins