Comparison of staged thoracoscopy and median sternotomy for lung volume reduction

doi:10.1016/S0003-4975(98)00801-7

The Annals of Thoracic Surgery

Volume 66, Issue 4, October 1998, Pages 1134-1138

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

https://doi.org/10.1016/S0003-4975(98)00801-7 Get rights and content

Abstract

Background. Lung volume reduction operations have proved beneficial for emphysematous patients, but questions remain about the role of a unilateral procedure.

Methods. Fifty patients were prospectively enrolled in a lung volume reduction surgery program for emphysema with staged unilateral video-assisted thoracoscopic procedures (VATS group). These patients were compared with 29 patients having bilateral lung volume reduction procedures by median sternotomy.

Results. The VATS group was slightly older and had shorter 6-minute walk distances, but otherwise the two groups were similar. Hospital stays were shorter for each unilateral VATS procedure, but the total of the two hospital stays was longer than the stay for the sternotomy group (21.1 versus 14.8 days). Complications were comparable, there were no in-hospital deaths, and there was significant difference in the 1-year mortality rate (VATS, 6% versus sternotomy, 13.8%; p = 0.137). Functional test results were comparable between the groups with improvements in percent predicted forced expiratory volume in 1 second (VATS, 41%, and sternotomy, 40%), 6-minute walk distances (VATS, 48%, and sternotomy, 26%), dyspnea scores, and acid base measurements.

Conclusions. Staged lung volume reduction operations do not appear to offer any measurable advantages over a single hospitalization and bilateral lung volume reduction procedures.

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

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Original ArticlesComparison of staged thoracoscopy and median sternotomy for lung volume reduction

Abstract

Section snippets

Material and methods

Results

Comment

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Chest

Ann Thorac Surg

Chest

J Thorac Cardiovasc Surg

Chest

J Thorac Cardiovasc Surg

Original Articles
Comparison of staged thoracoscopy and median sternotomy for lung volume reduction