The terms pleuroscopy, thoracoscopy, medical thoracoscopy, and video-assisted thoracic surgery are often used interchangeably to describe a minimally invasive procedure that provides access to the pleural space, parietal pleura, lung, and other structures within the thoracic cavity. Pleuroscopy is a more exact term for describing visualization of the pleura and contents of the pleural cavity using an endoscope. This procedure provides physicians a window into the pleural space, to perform biopsy of the parietal pleura under direct visual guidance, particularly for biopsies in cases of exudative effusions with unclear origin, chest tube placement, and pleurodesis to prevent recurrent pleural effusion or pneumothorax in selected patients. In this section we want to discuss the indications, contraindications, and complications of pleuroscopy, and its role in thoracic oncology.

Pleuroscopy offers physicians a unique opportunity for the evaluation of the pleural space and can be carried out in an endoscopy room or in the operating room. Its fascinating history has bridged continents and specialties and is intimately related to the history of optics and optical technologies. During the last decade, advances in video technology and improved endoscopic instrumentation have prompted a resurgence of interest in minimally invasive chest procedures among thoracic surgeons and interventional pulmonologists, and today, there is renewed enthusiasm for pleural investigations to manage both simple and complex pleural diseases. Pleuroscopy is effective in the evaluation of pleural and pulmonary diseases when routine cytology and closed-needle biopsy fail. In many institutions where facilities for pleuroscopy are available, it replaces second-attempt thoracentesis and closed-needle biopsy for patients with exudative effusions of unclear origin. Pleuroscopy also offers therapeutic intervention to break down loculations in early empyemas and to perform pleurodesis for recurrent malignant effusions and pneumothoraces, perhaps providing earlier referrals for VATS or open thoracic surgery if warranted. With the introduction of the semirigid pleuroscope, which is similar in design and handling to the flexible bronchoscope and compatible with standard light sources and video processors available in most bronchoscopy suites, pleuroscopy likely will be the object of expanded interest as both a diagnostic and therapeutic tool for pulmonary and critical care specialists experienced in flexible bronchoscopy. It is our hope that continual developments in equipment design along the lines of semirigid instrumentation and techniques will continue to evolve and that pleuroscopy will pave new roads, stimulating and directing novel pleural cancer research and education in the future.