ABSTRACT
I. SPECIAL CONSIDERATIONS The pleural space presents a uniquely convenient cavity for the performance of videoassisted minimally invasive procedures. A rigid bony thorax and collapsible lungs provide an opportunity to visualize the pleural space without requiring positive pressure insufflation. Diagnostic and therapeutic thoracoscopy was reported by the Swedish internist Hans Iacobaeus in 1919. He used a trocar and cystoscope with local anesthesia to drain pleural effusions and perform thoracoscopy. For the next 40 years thoracoscopy was primarily used for lysis of adhesions (pneumolysis) and treatment of tuberculosis. In the 1960s and early 1970s scattered reports of thoracoscopy generally using rigid instruments with distal light sources appeared. Video-assisted thoracoscopy (VATS) developed in the 1980s and 1990s in parallel with the development of video assisted laparoscopy.
