Background: Northumbria Healthcare NHS Foundation Trust runs a very successful pleural service catering for patients with malignant pleural fluid, pleural infection and pneumothorax. Local anaesthetic medical thoracoscopy (LAT) is a well-established diagnostic, therapeutic and preventative procedure in undiagnosed pleural effusions. Patients were traditionally admitted for a mean of 3.4 days and had a large bore drain inserted post LAT and pleurodesis was performed. The Covid-19 pandemic has forced us to provide day case LAT with IPC placement without pleurodesis to minise transmission risk. We thus describe our local experience. LAT is performed in theatre under conscious sedation. Methods: All the notes of patients requiring day case LAT between July 2020-Dec 2020 were analysed. Basic demographics were collected as well as diagnoses and what interventions were performed. A descriptive analysis of the data was performed. Results: 13 patients underwent day case LAT. All had negative preoperative Covid-19 swabs. Mean age was 69.7 years (range 24–82). 10 were male and 3 female. Definite diagnoses included 5 lung cancers, 4 mesotheliomas and 2 fibrinous pleuritis. The lung did not deflate, not allowing for biopsies in 2 patients. Non-malignant diagnoses are currently presumed. 10 IPCs and 1 large bore drain were inserted due to 1 immedidate complication (surgical emphysema). 1 patient developed an empyema within 30days. 8 out of the 10 IPCs have already been removed due to pleurodesis occuring (mean number of days 27.5, range 16–72). All patients were discharged on the same day except 1 patient who required a large bore drain and stayed overnight. Conclusions: We have thus transformed our service after more than a decade of providing LAT as an inpatient service. This is a small cohort of patients but proves the feasibility and safety of day case LAT with massive reduction in inpatient stay. The Covid-19 pandemic has transformed our service but for the better. Further qualitative work should elucidate the acceptability of such a pathway for patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
The feasibility of day case thoracoscopy