Introduction: Medical thoracoscopy (MT) is a minimally invasive procedure for inspection and biopsy of the pleural space and for therapeutic intervention. Here, we summarize our experience with MT at National Taiwan University Hospital, Hsin-Chu Branch. Methods: A retrospective chart review of patients who underwent MT procedures for diagnostic or therapeutic purposes for various pleural diseases or undiagnostic pleural effusion from December 2015 to August 2018 was performed. Those without a definite diagnosis were excluded. Results: Thirty-eight patients who underwent 40 MT procedures were enrolled in the present study. Twenty-one MT procedures were performed for diagnostic purposes, 5 for therapeutic purposes, and 14 for both diagnostic and therapeutic purposes during the same procedure. For the 35 diagnostic procedures, the overall diagnostic yield was 100%. Of the 19 procedures for therapeutic purposes, 18 were performed for adhesiolysis/fibrinolysis or decortication, and only 4 patients in this population required further treatment with surgical thoracoscopy. The remaining 1 patient had hepatic hydrothorax and underwent repair of a diaphragmatic defect. Conclusion: MT is practical for both the diagnosis and treatment of various pleural diseases.