Medical thoracoscopy in multiloculated and organised empyema.

agreed that there will be some patients in whom lysis of adhesions is not possible via medical thoracoscopy [5] , so close dialogue between medical thoracoscopists and thoracic surgeons remains key in pleural infection. This is, however, also important in nonempyematous septated effusions, and an early decision is needed as to whether VATS or decortication would be the optimal strategy [4–6] . Such a decision would naturally be influenced by whether level 2 medical thoracoscopy skills [2] , adjunctive therapies (such as fibrinolytics) and thoracic surgical expertise (level 3 skills) are available on site [7] .