METHODS: We performed an observational cohort study including all MT procedures performed by our program in three community hospitals. Patients were referred to the Interventional Pulmonology (IP) service for evaluation of recurrent exudative pleural effusion or for palliation of known or suspected malignant pleural effusion. Procedures were performed by an attending interventional pulmonologist. An IP fellow participated in most cases. The majority of MT cases were performed with ultrasound guidance and used a Wolf rigid thoracoscopy set (Richard Wolf, Vernon Hills, IL). All MT were performed under monitored anesthesia care in the operating room. Primary endpoints included major complications directly related to the MT such as clinically significant bleeding, infection, pneumothorax, respiratory failure, and any procedure related mortalities.