Evolution of medical thoracoscopy in developing countries

Pleural effusion constitutes around 25% of the workload in respiratory clinics yet the elucidation of underlying pathology in pleural effusion remains a diagnostic challenge. The most feared diagnosis in pleural effusion of unknown origin is malignancy, where the probability of a definitive diagnosis from aspiration, even in the most experienced hands, is approximately 60%.1 The dilemma, therefore, arises when considering the remaining 40%. Ideally these patients should have a pleural biopsy, either by medical thoracoscopy or video aided thoracoscopy by a thoracic surgeon. However, access to a thoracic surgeon remains a challenge in many developing countries and Pakistan is no exception. Medical thoracoscopy is a minimally invasive technique performed by pulmonologists under local anaesthesia. It can be used to visualise the pleural space, and allows diagnostic biopsies to be performed. Furthermore, it can be used to perform therapeutic procedures, such as drainage of massive