PT  - JOURNAL ARTICLE
AU  - Sahajal Dhooria
AU  - Navneet Singh
AU  - Ashutosh N Aggarwal
AU  - Dheeraj Gupta
AU  - Ritesh Agarwal
TI  - A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions
AID  - 10.4187/respcare.02738
DP  - 2013 Oct 08
TA  - Respiratory Care
PG  - respcare.02738
4099  - http://rc.rcjournal.com/content/early/2013/10/08/respcare.02738.short
4100  - http://rc.rcjournal.com/content/early/2013/10/08/respcare.02738.full
AB  - Background and aim: Thoracoscopic pleural biopsy increases the diagnostic yield of pleural effusions undiagnosed after thoracentesis, and is superior to closed pleural biopsy. Medical thoracoscopy can be performed using the rigid thoracoscope or the semirigid thoracoscope (pleuroscope). In this randomized trial, we compare the efficacy and safety of the two thoracoscopes. Methods: Patients with undiagnosed exudative pleural effusions were randomly assigned to undergo pleural biopsy either with rigid or the semirigid thoracoscope. The primary outcome was the diagnostic yield of the procedure while the secondary outcomes were requirement of sedative/analgesic agents, scar size, biopsy size and the operator’s view of the procedure. Results: Of the 145 screened patients with exudative pleural effusions, 90 were randomized to undergo thoracoscopy with the two thoracoscopes (n=45 each). The diagnostic yield of rigid thoracoscopy was superior to semirigid thoracoscopy (97.8% vs. 73.3%, p=0.002) on an intention-to-treat analysis but was similar (100% vs. 94.3%, p=0.18) in those with successful biopsy. The requirement of sedative/analgesic agents was higher in the rigid thoracoscopy arm. The scar size was slightly larger (mean±SD, 23.1±4 vs. 18.7±3.2 mm, p=0.0001), whereas the biopsy size was distinctly larger in the rigid arm (mean±SD, 13.9±4.4 vs. 4.4±1.4 mm, p=0.001). The operator rated visual analog scale (VAS) for the ease of taking a biopsy was significantly higher with the rigid instrument (mean±SD, VAS 86±12 vs. 79±12 mm, p=0.01) while the quality of image was superior in the semirigid arm (mean±SD, VAS 88±7 vs. 92±5 mm, p=0.002). The number of complications was similar in the two groups. Conclusions: Rigid thoracoscopy was found to be superior to semirigid thoracoscopy overall but the diagnostic yield was similar if pleural biopsy could be successfully performed. Due to the small sample size, a larger study is required to define the usefulness and choice between the two procedures. (Clinical trials.gov: NCT01726556)