S. Kanga (Dr), JY. Kimb (Prof), C. Paka (Prof), JH. Kima (Prof), SW. Raa (Prof), Y. Jegala (Prof), KW. Seoa (Prof), JJ. Ahna (Prof), T. Leea (Prof), G. Chae*a (Prof)

a Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, KOREA, REPUBLIC OF ; b Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan-Si, Chungcheongnam-Do, KOREA, REPUBLIC OF

* ganghee@uuh.ulsan.kr

Background: Semi-rigid medical thoracoscopy (MT) is a pleural procedure that could be easily performed by a pulmonologist. However, the flexible forceps biopsy through working channel of semi-rigid thoracoscope has a disadvantage in that the diagnostic yield is not high due to the small size of biopsy specimen (compared to the rigid forceps biopsy) and the procedure time is long to acquire a large number of biopsy specimens. To overcome these limitations, methods such as cryobiopsy have been used for MT. Recently, we have successfully used rigid forceps (used in rigid MT) in semi-rigid MT. We would like to share our experience and report short-term data on feasibility and safety.

Methods: Insertion of rigid forceps [34410MB (Karl Storz, Germany): outside diameter [OD] 5mm, length [L] 43cm; 10371L (Karl Storz, Germany): OD 2mm, L 35cm] was done with careful insertion tip rotation in the chest wall opening outside the dedicated trocar of semi-rigid thoracoscope [LTF-240 (Olympus, Japan)]. We retrospectively analyzed patients who underwent the semi-rigid MT using rigid forceps between November 2020 and April 2022 at Ulsan University Hospital.

Results: Forty patients [age (years, mean ± SD): 69.2 ± 12.8; male (n, %): 23, 57.5%] underwent semi-rigid MT using rigid forceps. All patients succeeded in inserting rigid forceps during semi-rigid MT. Regarding safety issues, no patients died due to complications related to the semi-rigid MT, and no significant bleeding or infectious complication was noted. Chest tube removal was successfully performed within 7 days in 75% (30/40) at 4.4 ± 2.1 day. The main cause of delayed removal was that the volume of drainage continued due to malignant effusion. The longest diameter of the biopsy specimens was 1.4 ± 1.2 cm, and definitive pathologic diagnostic yield was 80% (32/40).

Conclusion: In semi-rigid MT, pleural biopsy using rigid forceps was feasible and safely performed.

Disclosure of funding source(s): none