Original ArticlesComparison of staged thoracoscopy and median sternotomy for lung volume reduction
Section snippets
Material and methods
Fifty patients were prospectively enrolled in an LVRS program between April 1995 and October 1996 with the plan of staged unilateral thoracoscopic volume reduction procedures (VATS group). The second operation was carried out approximately 3 months after the first. This group was compared with 29 patients having LVRS through a median sternotomy (both lungs operated on) between July 1995 and August 1996.
Selection into the two surgical approaches was nonrandomized and based largely on patient
Results
All 50 patients had completion of the contralateral VATS volume reduction procedure within a 3- to 4-month interval after the first operation. The preoperative characteristics of this group were comparable with those of the sternotomy group except for age, residual volume, and 6-minute walk distance. The VATS group was older (67.5 versus 63.0 years; p ≤ 0.05) and had a shorter 6-minute walk distances (765 versus 945 ft; p ≤ 0.05) (Table 1). Residual volumes were significantly higher in absolute
Comment
The first lung volume reduction procedure, described by Brantigan and associates [16], was performed unilaterally through a thoracotomy. Similarly, in many reports of LVRS in the early 1990s, a unilateral approach with VATS was also used. The assumption was that because of the fragility of this patient population, a smaller incision and an operation on only one lung would be better tolerated. This presumption was questioned by Cooper and co-workers [2] and others who performed LVRS by
References (18)
- et al.
Thoracoscopic laser ablation of pulmonary bullae
J Thorac Cardiovasc Surg
(1994) - et al.
Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease
J Thorac Cardiovasc Surg
(1995) - et al.
Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema
J Thorac Cardiovasc Surg
(1996) - et al.
Stability of improvements in exercise performance and quality of life following bilateral lung volume reduction surgery in severe COPD
Chest
(1997) - et al.
Morbidity and mortality after thoracoscopic pneumonoplasty
Ann Thorac Surg
(1996) - et al.
Contribution of lung and chest wall mechanics following emphysema resection
Chest
(1996) - et al.
Unilateral thoracoscopic surgical approach for diffuse emphysema
J Thorac Cardiovasc Surg
(1996) - et al.
Bilateral lung volume reduction surgery for advanced emphysema
Chest
(1996) - et al.
A randomized, prospective trial of stapled lung reduction versus laser bullectomy for diffuse emphysema
J Thorac Cardiovasc Surg
(1996)
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