Local anaesthetic thoracoscopy practice in the United Kingdom in 2024 - a snapshot survey

Introduction: Local anaesthetic thoracoscopy (LAT) is widely available in the United Kingdom (UK). It is often the investigation of choice for unexplained exudative pleural effusions. There are no agreed national standards regarding LAT, with many sites following locally developed guidelines. The last survey of UK practice was in 2017. Methods: An electronic survey was circulated to UK Pleural Society (UKPS) members and through direct communication with centres known to be undertaking LAT. Invited centres were requested to distribute the survey further. Results: 37 responses were included. LAT remains the preferred investigation for an undiagnosed exudative pleural effusion (32/37, 87%). The number of trained thoracoscopists ranged from 1 to 6. Thirty centres (81%) had dedicated thoracoscopy lists with varying frequency. Nineteen (51%) centres routinely admitted patients post thoracoscopy (compared to 76% in 2017). Thirty centres (81%) did not routinely administer antibiotics. Thirty-five centres (95%) routinely used sedation, the commonest agent being midazolam, typically in combination with an opiate. Eleven centres (30%) utilised other pre-medications, whilst 8/37 (22%) of centres administered intravenous fluids. Where a minimal effusion is present 27/37 (73%) would induce a pneumothorax. Eleven (29%) centres would perform LAT for pleural infection. Only 11/37 (30%) of centres have on-site thoracic surgical support. Conclusions: There is wide variation in LAT practice amongst UK centres. These results support the need for identifying best practice and standardisation of LAT practices, with outcome reporting. These survey results will form the basis of applications to the national and international respiratory societies to develop relevant standards.