LAUSR

intercostal tube twice in patients undergoing MT (an initial tube of a small size followed by a large tube after MT). Regarding the performance of the MT, the authors have not mentioned the sedation protocol used for the MT, as it will affect the patient discomfort, procedure duration, ability to complete the procedure, and success achievement in pleural clearance. The proportion of patients undergoing rigid versus semirigid medical thoracoscopy is also not clear. The instrument used may also affect the procedure performance and success (4). The closed forceps used for adhesiolysis are usually large in case of rigid thoracoscope and may be more effective in comparison to thin forceps used with the semirigid instrument. Similarly, the use of a suction irrigation device may also affect the pleural clearance, and it cannot be routinely used for semirigid instruments. In the discussion, the authors have mentioned the utility of obtaining a pleural biopsy during MT to increase the microbiological yield. It is worth mentioning here that the pilot study quoted by the authors used ultrasound-guided pleural biopsies, which are feasible in the intrapleural fibrinolytic arm as well (5). There is no added advantage of MT in obtaining a pleural biopsy to increase the microbiological yield when it can be safely performed under ultrasound guidance. In view of these issues, we suggest that the trial results should be interpreted with caution while applying in routine clinical practice.