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Ann Thorac Surg 1998;66:1134-1139
© 1998 The Society of Thoracic Surgeons

Original articles: general thoracic

Comparison of staged thoracoscopy and median sternotomy for lung volume reduction

Stephen R. Hazelrigg, MDa, Theresa M. Boley, MSNa, Mitchell J. Magee, MDa, Carl H. Lawyer, MDa,b, Joseph Q. Henkle, MDa,b

a Division of Thoracic and Cardiovascular Surgery, Southern Illinois University School of Medicine, Springfield, Illinois USA
b Division of Pulmonary Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA

Address reprint requests to Dr Hazelrigg, Department of Surgery, SIU School of Medicine, PO Box 19230, Springfield, IL 62794-1312
e-mail: (shazelrigg{at}siumed.edu)

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

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.




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