Medical thoracoscopy (aka Pleuroscopy) is an intervention performed by a pulmonologist to visualize the pleural space either for diagnostic or therapeutic purposes. The primary purpose is to obtain a sample of pleural fluid for analysis in cases of unclear etiology, while obliteration of the pleural space by chemical pleurodesis is the most frequent therapeutic indication. Unlike video-assisted thoracoscopic surgery that requires general anesthesia with an endotracheal tube, medical thoracoscopy is usually performed under conscious sedation (typically midazolam/fentanyl/Benadryl) and sometimes with propofol deep sedation. It employs one and occasionally two ports to access the pleural space. Propofol is the most employed sedative for deep sedation, and some of the adjuncts are fentanyl, remifentanil, remimazolam, and dexmedetomidine. Nevertheless, local anesthetic medical thoracoscopy is commonly practiced in most parts of the world. Nerve blocks under ultrasound guidance such as paravertebral and erector spinae plane are other options. Complications are rare and include empyema, bleeding, port-site tumor growth, bronchopleural fistula, postoperative pneumothorax or air leak, pneumonia, and subcutaneous emphysema.