{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:05:48Z","timestamp":1790107548183,"version":"4.0.1"},"reference-count":46,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T00:00:00Z","timestamp":1709769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Introduction: Medical pleuroscopy (MP) is an invasive technique that provides access to the pleural space with a rigid or semi-rigid work instrument, allowing for visualization and the obtaining of bioptic pleural samples. Using pulmonologist-based analgosedation to perform pleuroscopy is still debated for safety reasons. The aim of this real-life study is to demonstrate the safety and diagnostic yield of MP performed under balanced analgosedation by a pulmonologist team with expertise in the management of critically ill patients in the respiratory intensive care unit (RICU) and interventional pulmonology unit as compared to video-assisted thoracic surgery (VATS) performed by a thoracic surgeon team under anesthesiologist-based analgosedation. Methods: In this multicentric retrospective controlled study, the inclusion criteria were patients older than 18 years old with pleural effusion of unknown diagnosis consecutively admitted in the years 2017\u20132022 to the pulmonology unit and RICU of San Donato Hospital in Arezzo (Italy, Tuscany) and to the thoracic surgery unit of Santa Maria Le Scotte in Siena (Italy, Tuscany) to undergo, respectively, MP under balanced propofol-based analgosedation on spontaneous breathing with local anesthesia provided by a pulmonologist team (Group A), and VATS provided by a surgeon team under propofol-based analgosedation managed by an anesthesiologist using invasive mechanical ventilation (IMV) via endotracheal intubation (ETI) (Group B). The primary endpoints were (1) a comparison between the two groups in terms of the diagnostic yield of pleural effusion, and (2) major and minor complications of pleuroscopic procedures. The secondary endpoints were (1) the length of the pleuroscopic procedure; (2) the duration of hospitalization; (3) propofol doses; and (4) the patient\u2019s comfort after the procedure assessed using the Visual Analogue Scale (VAS). Results: We enrolled 91 patients in Group A and 116 patients in Group B. A conclusive diagnosis was obtained in 97.8% of Group A vs. 100% of Group B (p = 0.374). Malignant effusion was diagnosed in 59.3% of Group A and in 55.1% of Group B; p = 0.547. No intraoperative or postoperative mortality events or major complications were observed in Group A. The major complications observed in Group B were three major bleeding events (p = 0.079) and one exitus (p = 0.315) not related to the interventional procedure. No significant difference emerged between the two groups in terms of minor complications. The duration of the intervention was significantly lower in Group A (40.0 min \u00b1 12.6 versus 51.5 \u00b1 31.0; p = 0.001). Pain control and, therefore, patient comfort were better in Group A, with an average VAS of 0.34 \u00b1 0.65 versus 2.58 \u00b1 1.26, p &lt; 0.001. The duration of hospitalization was lower in Group B (5.1 \u00b1 2.6 vs. 15.5 \u00b1 8.0, p &lt; 0.001). The average overall dose of propofol administered was significantly lower in Group A (65.6 \u00b1 35.8 mg versus 280 \u00b1 20.0 mg; p &lt; 0.001). Conclusions: This real-life study shows that the MP performed under propofol-based analgosedation by an independent pneumologist team is a safe and well-tolerated procedure with a diagnostic yield and complication rates similar to those obtained with VATS.<\/jats:p>","DOI":"10.3390\/diagnostics14060569","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T08:59:37Z","timestamp":1709801977000},"page":"569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Safety and Diagnostic Yield of Medical Pleuroscopy (MP) Performed under Balanced Analgosedation by a Pneumological Team Compared to Video-Assisted Thoracic Surgery (VATS): A Retrospective Controlled Real-Life Study (TORAPO)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3288-2808","authenticated-orcid":false,"given":"Valentino","family":"Allocca","sequence":"first","affiliation":[{"name":"Department of Translational Medical Sciences, \u201cLuigi Vanvitelli\u201d University of Campania, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Guidelli","sequence":"additional","affiliation":[{"name":"Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Cardio-Thoraco-Neuro-Vascolar Department, Usl Toscana Sudest, 52100 Arezzo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Galgano","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Department of Medical, Surgical and Neuroscience Sciences, S. Maria Le Scotte Hospital, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Benedetti","sequence":"additional","affiliation":[{"name":"Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Cardio-Thoraco-Neuro-Vascolar Department, Usl Toscana Sudest, 52100 Arezzo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Fabbroni","sequence":"additional","affiliation":[{"name":"Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Cardio-Thoraco-Neuro-Vascolar Department, Usl Toscana Sudest, 52100 Arezzo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4692-5901","authenticated-orcid":false,"given":"Andrea","family":"Bianco","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, \u201cLuigi Vanvitelli\u201d University of Campania, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9127-2102","authenticated-orcid":false,"given":"Piero","family":"Paladini","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Department of Medical, Surgical and Neuroscience Sciences, S. Maria Le Scotte Hospital, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Scala","sequence":"additional","affiliation":[{"name":"Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Cardio-Thoraco-Neuro-Vascolar Department, Usl Toscana Sudest, 52100 Arezzo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1136\/thx.2010.140236","article-title":"British Thoracic Society Pleural Disease Guidelines\u20142010 update","volume":"65","author":"Maskell","year":"2010","journal-title":"Thorax"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1016\/j.chest.2021.05.026","article-title":"Epidemiology of Adult Pleural Disease in the United States","volume":"160","author":"Mummadi","year":"2021","journal-title":"Chest"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Sumalani, K.K., Rizvi, N.A., and Asghar, A. (2018). Role of medical Thoracoscopy in the Management of Multiloculated Empyema. BMC Pulm. 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