Role of Cryobiopsy in Diagnosis of Pleural Effusion
Condition: Pleural Effusion
MeSH terms: Pleural Effusion
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the feasibility, size and quality of the specimens
      obtained by cryoprobe in comparison to those specimens obtained by flexible forceps during
      medical thoracoscopy in diagnosis of pleural effusion.
    

Detailed description: 
      -  Medical thoracoscopy with single-port-of-entry technique will be performed in the
           bronchoscopy unit under local anesthesia and conscious sedation using midazolam (2 mg)
           or pethidin.

        -  vertical incision will be made with the scalpel (usually near the midaxillary line),
           through the skin and subcutaneous tissue, appropriate to the size of the trocar to be
           used, usually of approximately 10 mm, parallel with and in the middle of the selected
           intercostal space.

        -  Then the trocar will be inserted until the sudden release of resistance (after passing
           the costal pleura) is felt.

        -  Under direct vision with the thoracoscope, introduction of pneumothorax will be
           performed, and all pleural fluid will be removed, and the pleural cavity will be
           inspected.

        -  Suspicious areas will be biopsied through the working channel of the thoracoscope.

        -  two to six biopsies of a suspicious pleural lesion will establish the diagnosis.

      Technique of pleural biopsy using cryotechnique:

        -  The probe (ERBE Elektromedizin GmbH( Gesellschaft mit beschränkter Haftung) , Germany of
           2.4mm) will be placed perpendicular to the surface of the parietal pleura with the tip
           of the probe extended well beyond the tip of the scope using the marking on the probe
           and with direct visualization.

        -  The tip of the cryoprobe will be attached to suspicious part of parietal pleura and
           activated by footswitch.

        -  carbon dioxide will be used as the cryogen gas for cryobiopsy

        -  The frozen tissue is going to be extracted by gently pulling of the probe.

        -  Freezing will be carried out for 6 to 10 seconds depending on the visual assessment of
           pleural texture.
    

Intervention name(s): Cryoprobe
Intervention type(s): Device
Intervention description(s): The probe (ERBE Elektromedizin GmbH; Tubingen, Germany of 2.4mm) will be placed perpendicular to the surface of the parietal pleura with the tip of the probe extended well beyond the tip of the scope using the marking on the probe and with direct visualization.
The tip of the cryoprobe will be attached to suspicious part of parietal pleura .
The frozen tissue is going to be extracted by gently pulling of the probe.
Freezing will be carried out for 6 to 10 seconds depending on the visual assessment of pleural texture.
The probe with the attached biopsy sample is going to be removed together with the thoracoscope through trocar.
The biopsy sample will be released from the probe by thawing in the saline.
The semirigid pleuroscope will be reintroduced through the port and the pleura will be revisualized for bleeding.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Cryobiopsy