الفهرس 
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Abstract
Pleural effusion is a common clinical disease characterized by pathological fluid accumulation in the pleural cavity. Pleural effusion may develop in many different conditions and the most common causes in adults are congestive heart failure, pneumonia, and malignancy, respectively.
To determine the etiology of pleural fluid, firstly, biochemical, cytological, and microbiological analysis of the fluid is required by thoracentesis; however, this procedure allows diagnosis in only about 60-75% of cases.
The etiology of exudative effusions varies by population, and the most undiagnosed exudative effusions are associated with malignancy or tuberculosis.
There are several means of managing pleural effusions which include thoracostomy tube placement with bedside chemical pleurodesis, thoracentesis, placement of an indwelling pleural catheter, pleurectomy and video-assisted thoracic surgery (VATS) drainage with chemical talc pleurodesis.
VATS has become a more common method for treating recurrent pleural effusions over the past few years. It is a less invasive alternative to a thoracotomy with or without pleurectomy. It provides various advantages over other methods of treatment which include complete initial drainage under direct visualization, talc placement for pleurodesis under direct visualization which allows for more adequate placement of talc and subsequently more effective pleurodesis.
In this study, we aimed to enhance the diagnosis of recurrent pleural effusion without introducing the patients to complication of intubated thoracoscopy.
This controlled clinical trial was conducted at tertiary care hospital at Suez Canal University Hospitals, Cardiothoracic Surgery Department from January 2022 to March 2023 andperformed on a total 100patients who presented with recurrent pleural effusion of unknown origin.
Our study results reported that 80.4% in intubated VATS group was unilateral pleural effusion, compared to 86.3% in Awake VATS group. Non-specific pleuritis as a final diagnosis was found in 80.4% and 84.3% in intubated VATS group and Awake VATS group respectively, with no statistically significant differences between the studied groups regardingClinical characteristics; laterality and final diagnosis.
As regards the operative time, our study results revealed that the time of operationwas 40.1±4.3 minutes in intubated VATS group, compared to 36.2±4.7 minutes in Awake VATS group with statistically significant difference between them.
As regards the postoperative pain, our study results revealed that there wereno statistically significant differences between the studied groups regarding postoperative pain management (VAS score).
As regards the complications, our study results revealed thatthe intraoperative complications ofcardiac arrhythmia and Self-limiting subcutaneous emphysema were non-significantly less frequent in awake VATS group (p value= 0.678, 0.617) respectively, and the postoperative complications of loculated effusion, Prolonged air leakage and expansion defect, Empyema and broncho-pleural fistula and long pleural drainage were non-significantly less frequent in awake VATS group.
We concluded that awake video-assisted thoracoscopic surgery is safe, has similar reliability and efficacy compared to video-assisted thoracoscopic surgery performed under general anesthesia as regards operative complications and postoperative pain, and is shorter in operative time. Therefore, it can be the first choice not only in patients with comorbidity, but in all patients.
We recommended that awake video-assisted thoracoscopic surgery should be used as an effective and safe tool in the diagnosis and treatment of patients with undiagnosed or recurrent pleural effusion not only in patients with comorbidity, but in all patients.