Thoracoscopy is divided into surgical thoracoscopy and medical thoracoscopy. Surgical thoracoscopy (VATS) is rigid, which requires 3-4 small 1.5cm chest wall incisions, general anesthesia, and double-lumen tracheal intubation to ensure safe operation on the affected side, but it is highly traumatic and expensive, and is not suitable for the diagnosis and treatment of some unexplained pleural diseases in internal medicine. Endo-thoracoscopy is a soft mirror, done by respiratory endoscopists under local anesthesia in the tracheoscopy room, with only a single incision in the chest wall, which is less traumatic and less expensive, and is the development direction of modern respiratory interventional pulmonology. The diagnosis of pleural diseases is a difficult point in the diagnosis and treatment of respiratory diseases. In April 2014, a patient with undiagnosed pleural effusion was referred to our department from Yunnan Provincial People’s Hospital, and our department cooperated with the director of thoracic surgery, Aiping Zhang, to take a biopsy of the lesion on the pleura using surgical thoracoscopy under general anesthesia, which was clearly identified as small cell lung cancer. In October 2014, our department independently carried out the first case of medical thoracoscopy under local anesthesia in the tracheoscopy room, which is convenient, fast, safe, painless and low cost. At present, this technology has significantly improved the diagnosis and treatment of pleural diseases in the Department of Respiratory Medicine.