Pleural Effusion & Pleurodesis
London

A pleural effusion is fluid in the pleural space, the thin cavity between the lung and the chest wall. It comes back after drainage when the cause has not been treated: a cancer involving the pleura, heart failure, infection, or a blood clot in the lung. Identifying the cause is the first step, because it determines whether the fluid needs sealing, draining long-term, or treating at its source.

The first drain is usually diagnostic as well as therapeutic: the fluid is sent for cytology and biochemistry. Where that does not give a diagnosis, or where the effusion has already returned, the next step is a biopsy of the pleura under direct vision and a decision about how to control the fluid for good. Those two things are done at the same keyhole operation.

Under general anaesthetic, a camera and instruments are passed through one or two small incisions in the side of the chest. The fluid is drained completely, the pleura is inspected and biopsied, and sterile talc is sprayed over the surface of the lung and the chest wall. The talc causes the two surfaces to inflame and stick together, closing the space where fluid collected. A chest drain stays in for two to three days, and most patients go home two to four days after the operation.

Pain is expected for the first days and is planned for: local anaesthetic blocks are placed by the surgeon at the end of the operation, and the ward pathway is the same enhanced-recovery pathway used after lung surgery. The biopsy result is available within days and is discussed with you and, where cancer is confirmed, at the multidisciplinary team meeting so that oncology treatment can start without delay.

Pleurodesis is the choice when the lung can expand fully to meet the chest wall and you are fit for a general anaesthetic: a single operation, a few days in hospital, and the fluid controlled in most patients. An indwelling pleural catheter is the choice when the lung is trapped and cannot expand, when a general anaesthetic is not appropriate, or when you prefer to avoid a hospital stay: a tunnelled silicone tube placed under local anaesthetic and drained at home two or three times a week.

Whether the lung will re-expand is judged on the CT scan and confirmed when the fluid is first drained. In some patients a catheter is placed at the same keyhole operation as the biopsy, and in some the lung sticks to the chest wall over the following weeks and the catheter is removed. Dr Okiror sets out both options at the consultation with the reasons for the recommendation.

Because a pleural effusion is a sign of an underlying disease, and the fluid alone often does not show which. Fluid cytology misses a proportion of cancers involving the pleura, and mesothelioma in particular often needs tissue taken under direct vision. At VATS the whole pleural surface can be seen and biopsied where it looks abnormal, so the operation that controls the fluid also answers the question of what caused it, under one anaesthetic and one hospital stay.

Where the cause is infection, the operation is different: the space is washed out and any thickened peel removed. Dr Okiror is Co-Principal Investigator and Lead Surgeon at Guy’s and St Thomas’ for the NIHR MIST-4 trial (ISRCTN16328099), which compares early keyhole surgery with enzyme therapy for pleural infection. Pleural infection is covered on the empyema page; suspected mesothelioma on the mesothelioma page.

Contact the practice. Patients who are unwell and attend the Urgent Care Centre at London Bridge Hospital are admitted directly to the ward, and surgery is usually within 48 hours. Transfers from NHS hospitals are arranged by the HCA Medical Concierge team. Urgent cases can be booked for surgery within 48 hours. For patients who are stable, the consultation is within 2–3 days, the scan is reviewed by Dr Okiror himself before the appointment, and the operation is usually within a week of completing investigations.

A guide price for VATS pleural biopsy with talc pleurodesis at London Bridge Hospital is £10,000–£14,000, covering hospital, surgeon and anaesthetist fees for an uncomplicated stay. Hospital charges are the largest part of the total. An indwelling pleural catheter and surgery for pleural infection are quoted individually after consultation. The hospital issues a written fixed quote after consultation and before treatment, and that quote is the figure that applies. All guide prices and how fees work →

Dr Okiror is recognised by AXA Health, Bupa, Aviva, Vitality, WPA and Cigna, and by most other UK and international insurers. If you have private medical insurance, Dr Okiror and the hospital bill your insurer directly, and insurers usually settle the hospital, surgeon and anaesthetist fees in full, less any excess written into your policy. Please confirm with your insurer that your policy covers treatment at London Bridge Hospital or The Lister before your first appointment. Self-paying patients are equally welcome.

At London Bridge Hospital, ranked tenth in the UK in the Newsweek World’s Best Hospitals 2026 list and the highest-ranked private hospital, or at The Lister Hospital in Chelsea. Consultations are also held at Canary Wharf and the City of London. In the NHS, Dr Okiror performs the same operations at Guy’s and St Thomas’, ranked first and second in the UK in the same list. Locations →