THORACOSCOPIC LASER PNEUMOPLASTY IN THE TREATMENT OF DIFFUSE BULLOUS EMPHYSEMA

Background. Thoracoscopic laser pneumoplasty in the treatment of diffu se bullous emphysema by means of a contact neodymium:yttrium-aluminum garnet laser was evaluated by a retrospective analysis of the first co nsecutive 500 procedures in 443 patients. The indication for thoracosc opic laser pneumoplasty was intractable dyspnea. Methods. Advanced age (mean age, 67 years), high oxygen dependency (70%); steroid use (46%) , and markedly diminished physical capacity (2% bedridden and 27% whee lchair-bound) were noted. Thoracoscopic laser pneumoplasty was carried out under general anesthesia and one-lung ventilation. Type 3 bullae (381 procedures) were contracted by contact neodymium:yttrium-aluminum garnet laser and type 4 bullae (119 procedures) excised. The operativ e mortality rate was 4.8%. Results. Subjective improvement was reporte d by 87% of the patients. Follow-up functional evaluation was availabl e in 229 patients, which showed highly significant improvement. A comp arison of preoperative and postoperative functional tests between type 3 and 4 bullae patients showed no significant difference, except the latter had higher decrease in airway resistance, residual volume, and total lung capacity. Conclusions. Thoracoscopic laser pneumoplasty is an effective treatment for both type 3 and 4 bullous emphysema with an acceptable risk.