Use of Robotic-Like Articulated Instruments in Medical Thoracoscopy: A Case Series.

Medical thoracoscopy (MT) is a minimally invasive procedure primarily used for diagnosing pleural diseases. However, its therapeutic role, especially in complex pleural infections, is underexplored. Rising pleural disease incidence and the need for less invasive treatment options have spurred interest in enhancing MT's capabilities. Disposable articulated wristed instruments, initially designed for laparoscopic surgery, offer improved dexterity and precision, potentially expanding MT's therapeutic use. We present three patients with complex pleural effusions managed with medical thoracoscopy (MT), utilizing articulated, robotic-like instruments (ArtiSential, LivsMed) under Monitored Anesthesia Care (MAC) at a tertiary care center:  A 67-year-old man with a recurrent, loculated exudative effusion underwent dual-port thoracoscopy due to high suspicion of tuberculous pleurisy versus malignancy. The use of articulated instruments enabled precise adhesiolysis and effective drainage, which ultimately facilitated diagnosis and successful initiation of anti-tuberculosis treatment.  A 64-year-old male with suspected malignant pleural effusion underwent single-port thoracoscopy. The use of an articulated dissector and an articulated monopolar spatula allowed for precise adhesiolysis, facilitating both diagnostic sampling and therapeutic intervention, including successful placement of a tunneled pleural catheter in a cleared pleural space  A 64-year-old COPD patient with anaerobic empyema had dual-port thoracoscopy. Articulated tools allowed precise debridement and evacuation without the need for adjunct fibrinolytic therapy. These cases demonstrate that articulated wristed instruments can enhance MT's precision and reach in complex pleural spaces, overcoming limitations of traditional tools. Their use broadens therapeutic options for patients unsuitable for surgery and supports MT as a minimally invasive, effective intervention. Continued innovation and research are essential to validate benefits on clinical outcomes and healthcare utilization, ensuring MT remains a vital tool in managing pleural diseases.