As mentioned above, the chest tube is usually uncomfortable and the patient usually needs analgesics. The second method uses thoracoscopy. A small incision or incisions are made in the skin and a small thoracoscope is passed through the incision to visualize the pleura. The sclerosing agent is placed under direct visualization onto the pleural surface. Complications with this procedure include a small risk for bleeding and infection.
Pneumothorax is uniformly present and requires a chest tube for a short time after the procedure.
Proponents of this procedure believe the sclerosing agent can be more efficiently applied to the pleura. However, there are no studies showing one method to be superior to the other. Several agents can be used for pleurodesis, including talc, bleomycin, and doxycycline. Unfortunately, not every patient with a symptomatic pleural effusion is a candidate for a pleurodesis and the procedure does not work in every case. Patients with a life expectancy of less than a few months generally are not candidates.