Videoscopic lung volume reduction surgery in an Australian public teachinghospital

Background: Lung volume reduction surgery (LVRS) has been a frequent litera ture topic in emphysema management recently. Opinions differ in regard to u sefulness, efficacy, and selection criteria. Aims: To present the results of our first 55 bilateral videoscopically rese cted group, with follow-up of up to three years, and to present some of the local methodology problems faced. Methods: Thirty-nine men and 16 women, age range 40-77, had either upper lo be (42), mixed (two), or lower lobe (11) resections without buttressing (ex cept for unilateral buttressing in several of the latter patients as part o f an intrapatient comparison trial) according to their pattern of emphysema determined by CT and perfusion scanning. Results: Thirty day mortality was 5.5%. Follow-up pulmonary function is ava ilable for 44 patients, and demonstrates a mean 51% improvement in FEV1, an d significant improvement in FVC, PaO2, dyspnoea indices and walking distan ce, with a reduction in mean RV, TLC, PaCO2. FEV1 improvement is maintained above baseline at three years. Lower lobe surgery outcomes are at least as good as their upper lobe counterparts. Conclusions: Outcomes confirm improvements reported elsewhere, and suggest that videoscopic resection may provide worthwhile benefit to lower lobe pat terns of emphysema. Other management issues are discussed.