Background: Malignant pleural effusion is common in patients with advanced malignant tumor. The aim of this study is to analyze the characteristics of pleural metastasis of renal clear cell carcinoma, pleural effusion under medical thoracoscopy and the diagnostic value of interventional thoracoscopy-guided biopsy, and to improve the understanding of pleural metastasis of renal clear cell carcinoma. Materials and Methods: 3 cases with pleural metastasis of renal clear cell carcinoma in our hospital were reported. The clinical characteristics and performs were retrospectively analyzed. In addition, a complete resection of tumor nodules was conducted by applying interventional electric knife and cryotechnique with thoracoscopy. Results: Three cases were all male and presented as dyspnea. By thoracoscopy testing, main lesions showed different size and amount nodules, and pleural thickening and congestion. Tumor tissues had abundant blood supplying and were crisp. Bleeding was easily caused in forcep biopsy, while complete resection of nodules could be achieved by an electric knife, and a larger number of samples were obtained. Conclusion: To our knowledge, pleural metastasis of renal clear cell carcinoma and formation of pleural effusion are rarely in clinic, most of whom are in male and presented as dyspnea. Medical thoracoscopy can directly displaying thoracic lesions and biopsy of adequate tissue through interventional techniques, which is important in the diagnosis pleural metastasis of renal clear cell carcinoma.