UNILATERAL VIDEO-ASSISTED THORACIC SURGICAL LUNG REDUCTION

Background. Lung reduction has been demonstrated to be a promising tre atment for end-stage emphysema when performed on both lungs via sterno tomy. The role for a thoracoscopic approach has not yet been determine d. Methods. Unilateral video-assisted thoracic surgical lung reduction was performed on 50 patients for the treatment of end-stage emphysema . There were 34 men and 16 women with a mean age of 61.5 years (range, 31 to 78 years). Emphysema was secondary to smoking in 45 patients (9 0%), and alpha(1)-antitrypsin deficiency in 5 patients (10%), 4 of who m had smoked in the past. Lung reduction was performed unilaterally us ing a thoracoscope and a stapled resection without the routine use of bovine pericardium. The side to be operated on and site of resection w ere determined preoperatively by examination of the perfusion and comp uted tomographic scans of the lungs. The average amount of lung remove d was 59 +/- 15 g (range, 29 to 111 g). Results. Morbidity included pr olonged air leak in 15 patients (30%), bleeding in 3 (6%), pneumonia r equiring reintubation in 3 (6%), myocardial infarction in 1 (2%), and perforated ulcer in 1 (2%). Seven patients (14%) required a second tho racic procedure for management of these complications. Two patients di ed, for an operative mortality of 4%. Follow-up obtained between 1 and 3 months in 25 patients revealed significant improvement in forced ex piratory volume in 1 second (0.71 to 0.95 L; p < 0.001), forced vital capacity (2.24 to 2.58 L; p < 0.01), and oxygen tension (59 to 67 mm H g; p < 0.01). The improvement in functional capacity as measured by 6- minute walk approached statistical significance (771 to 923 ft; p = 0. 06). Conclusions. Significant subjective improvement in dyspnea has be en noted in 41 of 48 hospital survivors (85%). For patients with end-s tage emphysema, unilateral video-assisted thoracic surgical lung reduc tion appears to be a preferable alternative to standard medical manage ment.