Objective. To analyze the findings and impact on the management of vi deo-assi sted thoracoscopic surgery (VATS) before planned abdominal exploration in patien ts with suspected advanced ovarian cancer and moderate to large pleural effusion s. Methods. We reviewed the charts of all patients with suspected advanced ovari an cancer and moderate to large pleural effusions who underwent VATS from 10/01 to 7/03. VATS was performed under double lumen endotracheal anesthesia. A 2-cm chest wall incision was made in the fifth intercostal space on the side of the e ffusion. The thoracoscope was introduced and biopsies of suspicious lesions were performed through the single incision. After VATS, all patients had a chest tub e placed through the incision, and those with malignant effusions underwent talc pleurodesis either intraoperatively or postoperatively. Results. Twelve patient s underwent VATS during the study period. Median operative time for VATS was 31 min (range: 20-49 min) with no complications attributable to the procedure. The median amount of pleural fluid drained was 1000 ml (range: 500-2000 ml). Solid , pleural-based tumor was found in six cases (50%), with nodules >1 cm noted i n four patients (33%) and nodules < 1 cm noted in two patients (17%). Of the s ix cases with no grossly visible pleural tumor, the pleural fluid was positive f or malignant cells in two patients (17%)-and negative in four patients (33%). Further initial patient management included the following: laparotomy with opti mal cytoreduction, 6 (50%); diagnostic laparoscopy, 3 (25%); and no abdominal exploration, 3 (25%). Final diagnosis of primary disease site was as follows: o vary, 9 (75%); fallopian tube, 1 (8%); endometrium, 1 (8%); and lymphoma, 1 ( 8%). Based on the findings duringVATS, laparotomy and attempted cytoreduction w ere avoided in four patients (33%), and the cytoreductive procedure was modifie d in one patient (8%). Conclusion. Fifty percent of patients with suspected adv anced ovarian cancer and moderate to large pleural effusions who underwent VATS had solid pleural-based tumor identified, and in 33%of cases the tumor nodules were >1 cm in diameter. VATS should be considered in these cases to delineate t he extent of disease, treat the effusion, and to potentially select patients for either intrathoracic cytoreduction or a neoadjuvant chemotherapy approach. Objective. To analyze the findings and impact on the management of vi deo-assi sted thoracoscopic surgery (VATS) before planned abdominal exploration in patien ts with suspected advanced ovarian cancer and moderate to large pleural effusion s. Methods. We reviewed the charts of all patients with advanced ovari an cancer and moderate to large pleural effusions who underwent VATS from 10/01 to 7/03. VATS was performed under double lumen endotracheal anesthesia. A 2-cm chest wall incision was made in the fifth intercostal space on the side of the e ffusion. The thoracoscope was introduced and biopsies of suspicious lesions were performed through the single incision. After VATS, all patients had a chest tub e placed through the incision, and those with malignant effusions underwent talc pleurodesis either intraoperatively or postoperatively. Results Twelve patients underwent VATS during the study period. Median operative time for VATS was 31 min (range: 20-49 min) with no compl The median amount of pleural fluid drained was 1000 ml (range: 500-2000 ml). Solid, pleural-based tumor was found in six cases (50%), with nodules> 1 cm noted in four patients Of the s ix cases with no grossly visible pleural tumor, the pleural fluid was positive f or malignant cells in two patients (17%) - and negative in (33%) and nodules <1 cm noted in two patients Further initial patient management included the following: laparotomy with opti mal cytoreduction, 6 (50%); diagnostic laparoscopy, 3 (25%); and no abdominal exploration, 3 (25%). Final diagnosis of (8%); and lymphoma, 1 (8%). Based on the findings during VATS, laparotomy and attempted cytoreduction w ere avoided in four patients (33%), and the cytoreductive procedure was modifie d in one patient (8%). Conclusion. Fifty percent of patients with suspect adv anced ovarian cancer and moderate to large pleural effusions who underwent VATS had solid pleural-based tumor identified, and in 33% of cases the tumor nodules were> 1 cm in diameter. VATS should be considered in these cases to delineate t he extent of disease , treat the effusion, and to potentially select patients for either intrathoracic cytoreduction or a neoadjuvant chemotherapy approach.