Yes, you may be able to use a 'conventional' bronchoscope for the thoracoscopy under local anesthetia. Of course the scope should be sterilization before the maneuver. Compared with a specific scope (i.e. OLYMPUS LTF TYPE 260 etc.), there are some weak points, the 'conventional' scope is 1. easy to wriggle in a thoracic cavity, 2. difficult to obtain biopsy because of the unfixation, 3. maybe more darker in the visual field. However, in my opinion, it is worth trying for the definitive diagnosis of the unknown pleurisy anyway. Let's go ahead!

Yes, you can use fiberoptic bronchoscop for thoracoscopy. However, it may not be useful for exact view of pleural cavity especially in cases with pleural adhesions. In addition, local anesthesia not supported with sedation is not comfortable for patients. Actually, VATS under general anesthesia is much better. If you think that you should get more effective specimen with correct bopsies, may be mini muscle sparing thoracotomy should be used.

I often use the fiberoptic bronchoscop in patients with Open Window Thoracostomy, to make a determination of the pleural cavity. These procedures are not real thoracoscopies but rather speleoscopies.

For simple procedures fiberoptic bronchoscop is good enough

During the 1950's through the 1970's, thoracoscopy was performed with rigid bronchoscopes and mediastinascopes using incandescent lights without magnification or video assistance. Diagnostic results were reasonable. Some experimented with flexible bronchoscopes and found them to be disorienting because of poor lighting and loss of sense of direction and orientation in a large cavity. However, in restricted cavities such as a mature, well drained empyema cavity, visualization was excellent. Flexible bronchoscopes are limited because of small lighting power and small suction and biopsy chambers. Rigid bronchoscopes offer a large space to insert much larger instruments through a single port. Under well defined situations with appropriately specific goals, one can make a case for each type of scope. For example, I used a flexible scope without anesthesia to serially evaluate the residual space in a chronically infected, post radiation, post pneumonectomy, post muscle flap covered bronchopleural fistula. I also serially evaluated a chromic apical space after upper lobectomy for Rasmussen's aneurysm.

As thoracoscopy is an invasive procedure, it's use should be limited with either rigid or semi-rigid bronchoscopy. Conventional bronchoscopy for medical thoracoscopy has limited usefullness due the inability to fix and maneuvering in the thoracic cavity with whatever little lung exapansion and becomes more difficult to visualize the pleura adequately in the presence of adhesions, and above all the piece of tissue obtain is tooooo small and is a heavy price for opening the thorax with added risk of infection.

You can use it but it is not optimal, becomes more difficult to visualize the pleura adequately. If is necesary for patiens you can do it.

flexible bronchoscope is problematic. i think you need to use a rigid one. other alternative is to use a mediastinoscope as it is rigid and has a wide enough working channal for inserting suction and biopsy forceps. most important is to have an OR sterile enviromets in order to prevent pleural cavity infection. Good luck.

That is a very tricky one. I have used a fibroptic bronchoscope instead of a thoracoscope in the case of pleural effusion and got good results of the biopsy of the areas of interest. There is however a catch. Instead of putting it via the trocar and cannula of a thoracoscope, it has to be manouvered via chest tube. The rigidity of the tube gives it that extra support for the major portion leaving the flexible distal portion free to manouver once beyond the tube. The holes of the ICT at times provide access to the diseased pleura where from a biopsy can be obtained. Also a visual scan of the pleura and the lung can be performed.

So in summary a bronchoscope can be made to function as a 'make-shift' thoracoscope if we pass it over a chest tube. In isolation it can simply not work but the ICT turns it in to a kind of flexirigid scope which is a pale version of the flexi-rigid thoracoscope and can function as one.

Excellent, i fully agree with Dr. Koul, it should certainly work

Yes, it will work, but generally you will obtain better results with an appropriate scope including 5mm optics. The only benefit of the flexible one I can see in a situation of multiple pleural adhesions where you can navigate the scope through the pleural cavity in a similar way like in the bronchi to achieve the desired area of the pleura for a biopsy. But usually disadvantages in comparison to the rigid optics should prevail.

Flexible Fibreoptic bronchoscope had been used for thoracoscopy in the early 1960s. I recall seeing an illustration of this procedure in the Facebook page of Chest journal :-) A purse string suture was applied around the intercostal puncture site and the ends of the suture were held by an assistant to restrain the bronchoscope. My curiousity is , if we use a Thoracoscope to break the pleural adhesions , will the cut ends along the visceral and parietal cause recurrent adhesions ?

Bronchoscopes should not be used for thoracoscopy unless they can be STERILISED. The majority of bronchoscopes are cleaned and disinfected but do not need sterilization. However, the risks are high in teh pleural cavity for introducing infection and hence all tool suse din teh pleural space should be STERILE.

Una toracoscopia se realiza perfectamente con un trócar una óptica y una pinza de biopsias.A través del trocar se introducen ambos instrumentos.Yo empecé practicándolas de ese modo. Con el fibrobroncoscopio se pueden realizar como las practicaba Ben Isaac.Pero hay tres inconvenientes :1º la biopsias son muy pequeñas y disminuyen los resultados positivos.2º.-es facil perderse dentro de la cavidad y en ocasiones ,si hay exceso de fibrina o adherencias no sabes donde estas y la exploración es incompleta o dificil sus resultados.3º .-Los roces del fibrobroncoscopio con el trocar pueden estropear la "camisa· que recubre el instrumento.

Pleuroscopy under local analgesia using a flexible bronchoscope is a simpler procedure at the bedside and suitable for the critical patients who cannot be moved to the operation or endoscopic room,In our institution, respiratory physicians have been performing the bedside flexible bronchoscopy as a pleursocopy for over 5 years in the ICU however there are still some limitations.

1.More difficult to manipulate within the pleural cavity than within the bronchi and do not provide a good orientation within the pleural space.

Method todo==>there is a learning curve that needs supervised by the experienced endoscopist and needs more practices

2. Flexible bronchoscopes have small spceimens in comparison with rigid thoracoscopes

Method todo===>so increasing the biopsy site ; more than 8-10 specimens

3.Damaged your rubber shirt of bronchoscopy

Method todo ===>tried to use chest tube or any sterilze tube to protect your tool.

However,there are different facilities available in the different countries or

different hospitals. In our chest department, we did not have the conventional (rigid or

semrigid) thoracoscopy. so the flexible bronchoscope was used as pleuroscopy in

the bedside once the critical patients were indicated for the pleuroscopy.

Completamente de acuerdo Ooi Hean .Con anestesia local y procurar que el trocar sea de plastico,no metalico, que daña menos la camisa de goma. Pero insisto que con cualquier óptica rigida (urología,digestivo,del mediastinoscopio,etc.) y una pinza de biopsias podemos a traves de un trocar realizar una toracoscopia con anestesia local .

Yes, Definitely agreed with Antonia Canto, that the plastic trocar should be considered when U are using bronchoscope as a pleruoscopy( I used plastic trocar and chest tube to protect the shirt of bronchoscope), help to diminish the damaged tool. Unfortunately, we did not have the conventional (rigid or semrigid) thoracoscopy in our hospital , I will use the rigid or semirigid thoracoscopy once available here.

Yes. It's possible, especially using a curved tocar for thoracoscopy. I'm owner of a patent for curved trocar for thoracoscopy (EP 1850768):A curved trocar for thoracoscopy to obtain a multidirectional vision and operativity of the pleural cavity with less discomfort to patients undergoing thoracoscopy under local anesthesia. The trocar consists of an external rigid cannula which short arm (1) continues through a 60°-70° curve (2) into a long arm (3) provided with blocking system (4); an internal stylet formed by a body (5) with blocking spheres (6), conic tip (7) and handle (8), in nylon or other resistant material. Introduced the short arm into the pleural cavity through the intercostals space, the stylet is removed and a flexible fiberoptic device may be introduced in the cannula. Inclinating and rotating the cannula altogether with the fiberoptic device, vision and operativity are multidirectional. It is also possible to insert a thoracostomic tube in the chosen position.

For a pdf prestentation or more details,you may contact me directly at: [email protected].

NOW We  are having the conventional (rigid or semrigid) thoracoscopy in my department , I am doing the medical thoracoscopy in my ICU bedside  for critical patients , It works smoothly, good orientation and good biopsy but the wound is  bigger than before...