Compliance and functional residual capacity after staple versus combined staple/holmium laser lung volume reduction surgery in a rabbit emphysema model

Background. There is some evidence to suggest that laser exposure, when add ed to standard staple reduction techniques, may result in improved physiolo gic response to lung volume reduction surgery (LVRS). In this study, we com pared physiologic responses of staple LVRS with combined staple/laser in a rabbit emphysema model. Methods. Ninety-three New Zealand White rabbits underwent emphysema inducti on with aerosolized elastase 4 weeks before surgery and were killed 1 week after surgery. Treatment groups were bilateral moderate volume staple LVRS (less than or equal to 3 g, n = 39), combined moderate volume staple (less than or equal to 3 g)/holmium laser LVRS (n = 18), large-volume staple LVRS (less than or equal to 3 g, n = 27), or sham surgery (n = 9). Results. Decrease in postoperative static respiratory system compliance by combined moderate-volume staple/laser treatment (1.22 cc/cm H2O) was simila r to large-volume staple resection (1.40 cc/cm H2O, p = 0.39), and superior to moderate staple resection (0.82 cc/cm H2O, p = 0.01) or sham surgery (0 .09 cc/cm H2O, p = 0.0001). Functional residual capacity decrease was great er after combined moderate staple/laser resection (6.46 cc) than large-volu me staple resection (4.52 cc, p = 0.33), moderate-volume staple resection ( 4.59 cc, p = 0.43), or sham surgery (4.10 cc, p = 0.29). Perioperative mort ality was highest after laser/staple LVRS (22%, 4/18). Conclusions. In this rabbit model, combined staple/ holmium laser reduction for emphysema results in significant improvement in compliance and trends toward improvement in functional residual capacity above staple reduction a lone, but with higher mortality. (Ann Thorac Surg 1999;68:1003-7) (C) 1999 by The Society of Thoracic Surgeons.