A local anaesthetic video-assisted thoracoscopy service: Prospective performance analysis in a UK tertiary respiratory centre
Introduction
Local anaesthetic video-assisted (“medical”) thoracoscopy performed using a single port under conscious sedation (LAVAT) allows drainage of a pleural effusion, multiple biopsies of the parietal pleura under direct vision achieving a high diagnostic yield and effective talc pleurodesis during one procedure [1]. It avoids the risks of general anaesthesia in patients, many of whom have comorbidities and reduced performance status. Thus it offers several advantages in the investigation of simple unilateral pleural effusion of unknown cause but particularly in suspected malignant pleural disease. However, it is not a substitute for video-assisted thoracoscopic surgery (VATS) in the investigation and treatment of complex pleural effusions.
UHL NHS Trust has a thoracic surgical unit with considerable expertise in VATS. With thoracic surgical support, we started a LAVAT service in 2005 in response to the need to develop a complementary pleural diagnostic service for patients with simple unexplained pleural exudates (and most commonly pleural malignancy). We prospectively audited our LAVAT service from 2005 to 2008 and conducted a cost analysis.
Section snippets
Methods
Prospective audit of all LAVAT procedures registered onto a database on the date the procedure was performed. Data were analysed using Graph Pad Prism version 4 software. Normality testing was assessed by the Ryan-Joiner test. Means and standard error (S.E.) in parentheses are quoted for normal data. Medians and inter-quartile range (IQR) in parentheses are quoted for nonparametric data. Box and whisker plots show median, IQR and extreme ranges. Two column data were analysed with either
Results
125 procedures were performed over a 34-month period, equating to 3.7 thoracoscopies per month or 44 annually. There was a male preponderance (75.2%) with mean (S.E.) age 69.9 (1.12) ranging from 27 to 88. The 10th–90th age percentiles were 54.8, 61, 66.2, 69, 71, 75, 77.8, 81 and 84, respectively.
Talc pleurodesis was performed in 66 (52.8%) of cases. Pleurodesis was effective (confirmed by failure of recurrence of the effusion on subsequent imaging or requiring further pleural drainage for at
Discussion
Our data confirm that our LAVAT service is safe and effective. LAVAT has a high diagnostic yield (91%) which fulfils the national thoracic surgical guidelines for VATS (90–95% yield for previously uninvestigated effusions) [3] and a high pleurodesis success rate (86.4%) which is better than for talc slurry in a recent prospective study [4] although a recent larger North American randomised trial of 501 patients failed to show any overall superiority for talc poudrage over slurry [5]. Our
Conflict of interest statement
The authors have no financial or personal conflicts of interest to declare.
Funding
None to declare.
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