Abstract Introduction: An undiagnosed pleural effusion is often a difficult diagnostic dilemma that needs further histological study for a definitive etiological diagnosis. Video assisted thoracoscopy is a minimally invasive procedure with a minor morbidity and mortality risk that could resolve this problem. Studies on its utility from developing countries like Bangladesh are limited. We herein describe our experience on the utility of Video assisted thoracoscopy from a tertiary care teaching and referral center in Bangladesh.