A local anaesthetic video-assisted thoracoscopy service: prospective performance analysis in a UK tertiary respiratory centre

Lung Cancer. 2009 Dec;66(3):355-8. doi: 10.1016/j.lungcan.2009.02.023. Epub 2009 Mar 29.


Introduction: Local anaesthetic video-assisted thoracoscopy (LAVAT) is a safe, reliable and therapeutic procedure used by respiratory physicians in the management of pleural disease, especially pleural malignancy. We describe a prospective analysis of a UK LAVAT service set up in a tertiary respiratory centre to complement an existing large surgical video-assisted thoracic surgery (VATS) service.

Methods: A prospective analysis of 125 LAVAT procedures over a 34-month period was performed looking at a variety of quality control endpoints comparing them to national thoracic surgical VATS standards.

Results: Talc pleurodesis was effective in over 86% of cases and this did not significantly lengthen bed stay (median 4.5 days). Bed stay was also unchanged between the ages of 60-89 years. Over 77% of the 48 patients with proven metastatic pleural lung malignancy or mesothelioma received either surgical decortication or oncological treatment (palliative chemotherapy in 57%). In only 6% were biopsies not possible because of technical factors. LAVAT biopsies had a diagnostic accuracy of 97.4%, sensitivity 95.4%, specificity 100%, positive predictive value 100%, and negative predictive value 94.7%. Our complication rate was 4% and mortality rate 0.8%.

Discussion: Our LAVAT service meets surgical VATS standards for diagnosis and safety with a good pleurodesis efficacy rate. It complements our surgical VATS service, offering a pleural diagnostic service for patients with non-complex pleural exudates or too frail for VATS. Our data demonstrate there is a demand and potential for respiratory physicians dealing with pleural malignancy to develop LAVAT and enhance their local lung cancer and pleural diagnostic pathway.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biopsy*
  • Health Services
  • Humans
  • Length of Stay*
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / economics
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy*
  • Middle Aged
  • Neoplasm Metastasis
  • Predictive Value of Tests
  • Prospective Studies
  • Quality Assurance, Health Care*
  • Respiratory Care Units
  • Thoracic Surgery, Video-Assisted*
  • United Kingdom