INTRODUCTION: Medical thoracoscopy also referred to as pleuroscopy is an endoscopic evaluation of the pleural space. It is a minimally invasive procedure invented in 1910 by Hans Christian Jacobeus who is regarded as ‘Father of Thoracoscopy’. Thoracoscopy was mainly used in the etiological diagnosis of pleural effusions. It is also useful in evaluation of pneumothorax, empyema & therapeutic procedures like pleurodesis and adhesiolysis may be done. In patients with pleural effusions, cytobiochemical analysis of pleural fluid establishes etiology in upto 60% of cases. In around 20% of cases etiology remains unclear and in this context thoracoscopy becomes an important investigation modality. Forceps biopsy, pleural brushings and FNAC from pleural lesions using TBNA needle could be used through medical thoracoscope to obtain specimens. AIM: To study the role of thoracoscopic pleural biopsy, pleural brushings and FNAC using TBNA needle in undiagnosed exudative pleural effusions. METHODOLOGY: It is a prospective study taken up by the department of pulmonary medicine of SVS medical college and hospital, Mahabubnagar, Telangana. All the enrolled cases of undiagnosed exudative pleural effusion which satisfy the inclusive criteria were taken into the study from January 2018 to November 2018. Total of 20 patients were satisfying the inclusive criteria and were further studied for their thorocoscopic findings. The study was started after taking the approval of Institutional Ethics Committee, SVS medical college and hospital, Mahabubnagar, Telangana. RESULTS: A total of 20 patients were enrolled in the study, out of which 80% (16) were males and (20%) 4 were females. Total patients diagnosed with malignancy were 60% (12). Rest 40% (8) were all diagnosed with Tuberculosis. The diagnostic yield of forceps biopsy, pleural brushings and FNAC with TBNA was 100%, 85%, 65% respectively.