CASE PRESENTATION: 81 years old female with Stage IV NSCLC on Nivolumab with known recurrent malignant pleural effusion diagnosed in May 2015, who underwent Pleurex catheter placement on 10/7/2015 complicated by catheter occlusion that did not have a lasting response to tPA treatment. She underwent a medical throacoscopy with lysis of adhesions and talc pleurodesis on 10/30/2015. During the procedure, complex extensive adhesions were lysed with ease using suction irrigator (StrykerFlow 2, Stryker, Kalamazoo, MI) through the rigid thoracoscope under direct visualization. Talc pleurodesis was performed after. Successful pleurodesis was confirmed on followup clinic visit with significant symptom improvement.