SINGLE-STAGE, BILATERAL, VIDEO-ASSISTED THORACOSCOPIC LUNG-VOLUME REDUCTION SURGERY FOR END-STAGE EMPHYSEMA

The reintroduction of lung volume reduction surgery has provided funct ional improvement for selected patients afflicted with end-stage emphy sema. Evolution of the operation from a median sternotomy approach to the two-stage video-assisted thoracoscopic surgical technique in our e xperience has resulted in a faster return to full activity. Nineteen p atients underwent video-assisted thoracoscopic Lung volume reduction s urgery between July 1995 and August 1997, The 12 men and 7 women in th e study had an average age of 63.7 years. All patients were evaluated preoperatively with computed tomography of the chest, radionuclide lun g perfusion scan, left ventricular stress test, right heart catheteriz ation, and a monitored rehabilitation program. In 15 patients the oper ation was performed as a bilateral single-stage procedure, The operati on involved resection of wedges from the upper lobes and in 10 of thes e patients from the lower lobes as well. In all patients the estimated operative blood loss was less than 150 mi. The mean operative time wa s 177 minutes (range 115-235 minutes). The mean length of hospital sta y was 10.8 days (median 11 days, range 5-24 days). At 2 to 3 months' f ollow-up increases were noted in the FEV1, (51%), PaO2, (27%), and 6-m inute walk distance (18%); and there was a decrease in total lung capa city and respiratory volume. No significant change was observed in car bon monoxide diffusion in the lung. Morbidity included persistent air leaks in three patients and refractory supraventricular tachyarrhythmi a in one. There were no perioperative deaths, We therefore recommend t his technical modification to reduce operating time and blood loss wit hout compromising surgical exposure or outcome.