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Ann Thorac Surg 1995;60:936-942
© 1995 The Society of Thoracic Surgeons

Articles

Thoracoscopic laser pneumoplasty in the treatment of diffuse bullous emphysema

MD Akio Wakabayashi*

The Wakabayashi Institute at Irvine Medical Center, Irvine, California, USA

Accepted for publication April 24, 1995.

* Address reprint requests to Dr Wakabayashi, The Wakabayashi Institute at Irvine Medical Center, 16300 Sand Canyon Ave. Suite 100, Irvine, CA 92718.

Background.: Thoracoscopic laser pneumoplasty in the treatment of diffuse bullous emphysema by means of a contact neodymium:yttrium-aluminum garnet laser was evaluated by a retrospective analysis of the first consecutive 500 procedures in 443 patients. The indication for thoracoscopic laser pneumoplasty was intractable dyspnea.

Methods.: Advanced age (mean age, 67 years), high oxygen dependency (70%), steroid use (46%), and markedly diminished physical capacity (2% bedridden and 27% wheelchair-bound) were noted. Thoracoscopic laser pneumoplasty was carried out under general anesthesia and one-lung ventilation. Type 3 bullae (381 procedures) were contracted by contact neodymium:yttrium-aluminum garnet laser and type 4 bullae (119 procedures) excised. The operative mortality rate was 4.8%.

Results.: Subjective improvement was reported by 87% of the patients. Follow-up functional evaluation was available in 229 patients, which showed highly significant improvement. A comparison of preoperative and postoperative functional tests between type 3 and 4 bullae patients showed no significant difference, except the latter had higher decrease in airway resistance, residual volume, and total lung capacity.

Conclusions.: Thoracoscopic laser pneumoplasty is an effective treatment for both type 3 and 4 bullous emphysema with an acceptable risk.




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