UNILATERAL THORACOSCOPIC SURGICAL APPROACH FOR DIFFUSE EMPHYSEMA

We evaluated the use of a lateral thoracoscopic approach for lung redu ction surgery in patients with diffuse emphysema, Sixty-seven patients with a mean age of 61.9 years underwent operation. Operative side was determined by preoperative imaging, The procedures were laser ablatio n in 10 patients and stapler resection in 57 patients, Ten patients, i ncluding six of the 10 patients in the laser-only group had poor outco me (death or hospitalization longer than 30 days), leading us to aband on the laser technique, Of the remaining 57 patients undergoing primar y stapled resection, duration of chest tube placement averaged 13 days (range 3 to 53 days),vith a mean hospital stay of 17 days (range 6 to 99 days), Seven patients required ventilation for longer than 72 hour s, six patients underwent conversion of the procedure to open thoracot omy, four patients acquired arrhythmias, and three patients were treat ed for empyema, There was one early death (1.7%), from cardiopulmonary failure, Forty patients returned for 3-month evaluation, Significant (p < 0.0001) improvements were seen in forced vital capacity (2.69 L a fter vs 2.26 L before) and forced expiration volume in 1 second (1.04 L after vs 0.82 L before), with 25 of 30 patients (63%) showing an imp rovement of more than 20%, Lung volume measures, in particular residua l volume, fell significantly. Arterial blood gas analysis revealed tha t carbon dioxide tension fell significantly in patients with preoperat ive hypercapnia (carbon dioxide tension >45 mm Hg, p = 0.018), Six-min ute walk lest results improved (894 feet after vs 784 feet before, p = 0.002), and symptomatic benefit was confirmed by significant improvem ent in the dyspnea index, The combination of both hypercapnia and redu ced single-breath diffusing capacity for carbon monoxide was significa ntly more frequent (p = 0.0026) and was 86% specific (5 of 6 patients) in predicting serious postoperative risk, We conclude that the latera l thoracoscopic surgical approach to diffuse emphysema offers signific ant improvement in pulmonary mechanics and functional impairment, Pati ents with a combination of hypercapnia and reduced single-breath diffu sing capacity for carbon monoxide should not be considered for this pr ocedure because of significant perioperative risk.