IP Fellows Reading List


Advances in pleuroscopy



Reference: Anevlavis S and Froudarakis M. Advances in Pleuroscopy. The Clinical Respiratory Journal 2018; 12(3):839–847. doi:10.1111/crj.12597.

Summary: This review article describes traditional pleuroscopy technique and various clinical uses for this procedure. It also describes newer techniques such as minithoracoscopy, semi-rigid thoracoscopy, narrow band imaging pleuroscopy, infrared pleuroscopy and auto-fluorescence pleuroscopy. Medical thoracoscopy is the procedure of choice for the investigation of undiagnosed exudative pleural effusions. It can also be useful in the management of various pleural conditions.

 Medical thoracoscopy/pleuroscopy: step by step



Reference: Loddenkemper R, Lee P, Noppen M, Mathur PN. Medical Thoracoscopy/Pleuroscopy: Step by Step. Breathe 2011; 8(2):156–167. doi:10.1183/20734735.011611. https://breathe.ersjournals.com/content/8/2/156

Summary: This article describes the necessary knowledge and skills for performing a thoracoscopy, contraindications and potential complications as well as a detailed description of available equipment and procedural technique.

Rigid mini-thoracoscopy versus semirigid thoracoscopy in undiagnosed exudative pleural effusion: the mint randomized controlled trial


Clinical Trial

Reference: Bansal S, Mittal S, Tiwari P, et al. Rigid mini-thoracoscopy versus semirigid thoracoscopy in undiagnosed exudative pleural effusion: the mint randomized controlled trial. J Bronchology Interv Pulmonol. 2020;27(3):163-171.

Background: This is a small, randomized controlled trial evaluating the performance of rigid mini thoracoscopy and semirigid thoracoscopy for pleural biopsies in undiagnosed exudative pleural effusions.


Population –
  • Adult patients with undiagnosed pleural effusions undergoing thoracoscopy for pleural biopsies (n=73)
Intervention –
  • Mini thoracoscopy (n=36)
Comparison –
  • Semirigid thoracoscopy (n=37)
Outcome –
  • Diagnostic yield was the primary outcome. The diagnostic yield of pleural biopsy between the mini-thoracoscopy and semirigid thoracoscopy were not significantly different
  • Patient related pain scores were significantly higher in the mini-thoracoscopy group as measured by visual analog scale
  • Biopsy size was significantly larger in the mini-thoracoscopy group compared to semirigid thoracoscopy group
  • There were no serious adverse events in either group
Take home: Diagnostic yield is similar between semirigid and mini-thoracoscopy instruments. Patients undergoing semi-rigid thoracoscopy may experience less pain as this study suggests.

Pleural cryobiopsy: a systematic review and meta-analysis



Reference: Shafiq M, Sethi J, Ali MS, Ghori UK, Saghaie T, Folch E. Pleural cryobiopsy: a systematic review and meta-analysis. Chest. 2020;157(1):223-230.

Summary: Pleural biopsies obtained with video-assisted thoracoscopic surgery or medical pleuroscopy have a high diagnostic yield for pleural pathology. Pleural cryobiopsies may increase the diagnostic yield by providing larger pieces of tissue and reducing crush artifact. This is a systematic review and meta-analysis of pleural cryobiopsies comparing the diagnostic yield to that of flexible forceps biopsies. Based on the analysis of the data from seven observational studies, pleural cryobiopsies do not increase the diagnostic yield over flexible forceps biopsy but are safe to perform. Further multicenter randomized trials are needed.