Background: Medical thoracoscopy (MT) is one of the oldest invasive interventional techniques in the recent history of respiratory medicine. Its role in clinical practice was emphasized in the last few years, and it almost replaced the traditional closed pleural biopsy method. Aim of the Study: To evaluate the safety and the rate of possible complications during and after medical thoracoscopy performed for diagnostic purposes at a single centre in Cairo, Egypt. Patients and Methods: This is a retrospective analytical study of data collected from the medical records of all patients (226 patients) that underwent diagnostic medical thoracoscopy at our center in successive three years. Results: The mean age of the study patients was 55.37 ± 13.69 years, 125 (55.3%) of them were males, while 101 (44.7%) were females and 137 patients (60.62%) had a risk of asbestos exposure. Persistent air-leak ≥7 days was the most frequent major thoracoscopic complication, detected in 10 patients (4.42%), followed by hypoxemia in 9 patients (3.98%), then post-procedure pneumonia and arrhythmia in 5 patients (2.21%) for each. The most common minor thoracoscopic complication was post-procedure pain in 74 patients (32.74%), followed by transient air-leak <7 days in 25 patients (11.61%) then post-procedure unexplained fever in 23 patients (10.17%) and subcutaneous emphysema in 19 patients (8.4%). Conclusion: Medical thoracoscopy is a simple, valuable and safe diagnostic procedure, which carries a limited possibility of complications, most of them are not serious and easy to be controlled.