Pleuroscope

Pleuroscope refers to an endoscopic instrument used to examine the pleural space. It is employed during pleuroscopy, also known as thoracoscopy, to visualize pleural surfaces, sample pleural tissue, and perform therapeutic maneuvers. Pleuroscopes can be rigid or flexible and are connected to a light source and video imaging system. Access to the pleural cavity is gained through a small intercostal entry under sterile conditions.

History and design: Thoracoscopy began in the early 20th century, with modern pleuroscopes offering video-assisted visualization. Rigid devices remain common for direct, high-contrast imaging, while flexible or semi-rigid scopes provide greater maneuverability in pleural spaces. Contemporary systems often deliver high-definition imaging and may include biopsy forceps, suction, and, in some configurations, ultrasound guidance.

Indications and procedure: Pleuroscopy is used to evaluate undiagnosed unilateral pleural effusions, to investigate suspected malignant pleural disease, and to assess or treat pleural infections. It enables pleural biopsy, targeted sampling of suspicious lesions, and therapeutic interventions such as drainage of effusions, mechanical debridement, talc pleurodesis, or placement of indwelling pleural catheters. Technique typically involves local anesthesia with sedation or general anesthesia, with the patient in a lateral or semierect position. After one or more small port entries, the pleural space is inspected, abnormalities are documented, and specimens are obtained as needed. Therapeutic steps are performed under direct visualization.

Outcomes and safety: Diagnostic yield is influenced by disease extent and operator experience. Pleuroscopy is generally safe when performed by trained teams, but potential complications include bleeding, infection, pneumothorax requiring chest drainage, and injury to adjacent structures. Contraindications include uncorrected coagulopathy, severe cardiopulmonary compromise, extensive pleural adhesions, or inability to tolerate the procedure.