Thoracoscopic lung biopsy. Experimental and clinical preliminary study.

We have investigated thoracoscopic lung biopsy (TLB) as an alternative to surgical biopsy. TLB was performed under mild general anesthesia, with two openings: one for the telescope, and one for a 5 mm in diameter biopsy forceps connected to diathermocoagulating device. TLB was first tested on 14 dogs (22 TLB) and then on 75 subjects (77 TLB): 35 patients with pleural diseases and 40 patients with undiagnosed lung diseases despite previous investigations including transbronchial biopsy.

Thoracoscopy in malignant pleural effusions.

In a consecutive series of 1,000 patients admitted since 1970 for pleural effusions, 215 with undiagnosed chronic effusions (with previous negative cytologic and needle biopsy results) underwent thoracoscopy. The investigation was usually performed under general anesthesia, originally with a 9-mm diameter cold light laparoscope, but, since 1978, with a 7-mm diameter thoracoscope of our design with biopsy forceps connected to a diathermocoagulating device. Thoracoscopy diagnosed 131 of 150 malignant effusions in the series.

[Intrapleural talc in malignant pleural effusions (author's transl)].

Intrapleural talc poudrage was carried out at the end of thoracoscopy in 77 patients after complete aspiration of fluid with uniform insufflation over the whole surface area of the pleura of 4 to 5 ml of pure talc, asbestos free. A continuous suction drain was left in place for 3 to 6 days. Amongst these patients, there were 57 cases of pleural effusion due to metastases and 20 mesotheliomas.

[Lung biopsy by thoracoscopy (author's transl)].

60 patients had 1 to 7 biopsies during thoracoscopy under light anaesthesia without tracheal intubation. Biopsies were performed under direct vision using a separation puncture. Double-spoon biopsy forceps (5 mm in diameter) connected to a 120 watt diathermy apparatus avoided any air leak age and ensured haemostasis as the biopsy was taken.

[Current indications for thoracoscopy].

Thoracoscopy is performed at best with a rigid apparatus and a cold light source using a single or double site of entry into the chest. Biopsy under direct vision requires a double-spoon biopsy forceps that can be connected to diathermy to insure haemostasis and prevent any air leak age. Some authors prefer a local anaesthesia but a light general anaesthesia with or without intubation allows a safe and painless examination.