Rigid Mini-Thoracoscopy: The New Kid on the Block

Our plain-English summary of Rigid Mini-Thoracoscopy: The New Kid on the Block, by E.O. Bedawi, N.M. Rahman (Journal of Bronchology & Interventional Pulmonology, 2020).

The study

• Authors: E.O. Bedawi, N.M. Rahman
• Journal: Journal of Bronchology & Interventional Pulmonology
• Published: 2020;27(3):157-159
• Type of article: Historical article
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial commented on the MINT randomized controlled trial by Bansal and colleagues, which compared a new rigid mini-thoracoscope with semirigid thoracoscopy. The editorial's authors first reviewed the history of thoracoscopy. They noted that UK centres offering local anaesthetic thoracoscopy more than trebled from 11 to 37 between 1999 and 2009, and that case series reported diagnostic yields of 96% to 98.4%. They described the relative merits of rigid and semirigid instruments. Rigid instruments allowed larger, deeper biopsies, which the authors described as particularly important in diagnosing mesothelioma. Semirigid instruments offered easier handling. The new rigid mini-thoracoscope had a 5.5 mm endoscope with a 3.5 mm working channel. The single-centre MINT trial enrolled 73 patients with undiagnosed exudative pleural effusion. Diagnostic yield was 69.4% with the rigid mini-thoracoscope and 81.1% with semirigid thoracoscopy. Nonspecific pleuritis was frequent (29.7%), and a definitive diagnosis was reached in 67.6%. Patient-rated pain was significantly higher with the rigid mini-thoracoscope. The editorial's authors attributed the yield difference largely to the small sample size and noted possible effects of operator experience. They concluded that the device was not yet established but that the data would help plan larger studies. They suggested that the choice of instrument be guided by operator training and experience and by the local prevalence of conditions such as mesothelioma and tuberculosis.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article is an editorial, not a new study. The authors gave background on thoracoscopy, a procedure for examining the pleura (the lining around the lungs) and taking biopsies. They then commented on a separate randomized trial by Bansal et al, called MINT. That trial compared a new rigid mini-thoracoscope with a semirigid thoracoscope in 73 patients with undiagnosed exudative pleural effusion. As the editorial reports it, the trial found a diagnostic yield of 69.4% with the rigid mini-thoracoscope and 81.1% with the semirigid thoracoscope. Patient-rated pain was significantly higher with the rigid mini-thoracoscope. The editorial authors wrote that the difference in yield was likely due to the small sample size. They added that operator experience and the difficulty of blinding operators could affect the findings. They noted that diagnosing mesothelioma requires biopsies that include fat. The authors concluded that the data suggest the rigid mini-thoracoscope has not been established in pleural practice, but that the limitations of the data should be taken into account. No asbestos exposure was studied.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Editorial commenting on a separate randomized controlled trial (the MINT study by Bansal et al); no new data were collected
• Who was studied: No population of its own. The trial discussed (Bansal et al) included 73 patients with undiagnosed exudative pleural effusion at a single center.
• Exposure: No asbestos exposure was studied. The subject is thoracoscopy instruments: the Rigid Mini-Thoracoscope (Richard Wolf, Germany) compared with the semirigid thoracoscope.
• Main results:
  • As reported in the editorial, the MINT trial (Bansal et al) found a diagnostic yield of 69.4% for rigid mini-thoracoscopy compared with 81.1% for semirigid thoracoscopy.
  • The editorial authors wrote that the difference in diagnostic yield was likely due to the trial's small sample size, as shown by wide confidence intervals.
  • As reported in the editorial, in the MINT trial a definitive diagnosis was obtained in 67.6% of patients. Malignancy accounted for 52.1% of cases and tuberculosis for 18.2%.
  • As reported in the editorial, patient pain measured by visual analog score was significantly higher with rigid mini-thoracoscopy in the MINT trial.
  • The editorial authors stated that deeper biopsies that include fat are required to diagnose mesothelioma.
• The authors' conclusion: The authors concluded that the data suggest rigid mini-thoracoscopy has not been established in the pleural intervention suite, but that the limitations of the data should be taken into account.
• Limitations the authors state:
  • The editorial authors noted that the trial findings on biopsy size, operator-rated pain and scope maneuverability could be due to operators being more experienced with the semirigid thoracoscope.
  • The editorial authors noted that blinding operators is always a challenge in interventional studies of this kind.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Thoracoscopy, Mesothelioma, Pleural Effusion.

Related studies

• Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions — Y. Yin, R. Eberhardt, et al. (2016)
• Thoracoscopy in the early diagnosis of malignant pleural effusions — C. Boutin, P. Cargnino, et al. (1980)
• Outcomes and complications following medical thoracoscopy — F.J. Brims, M. Arif, et al. (2012)
• Diagnostic accuracy and safety of semirigid thoracoscopy in exudative pleural effusions in Denmark — F. Willendrup, U. Bodtger, et al. (2014)
• The safety of medical thoracoscopy in a group at high risk for complications — M. Metintas, G. Ak, et al. (2013)
• Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography — Y. Watanabe, S. Sasada, et al. (2014)

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