HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John R. Roberts Joseph E. Bavaria Joseph S. Friedberg Larry R. Kaiser Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Roberts, J. R. Articles by Kaiser, L. R. Search for Related Content PubMed PubMed Citation Articles by Roberts, J. R. Articles by Kaiser, L. R.

Ann Thorac Surg 1998;66:1759-1765
© 1998 The Society of Thoracic Surgeons

---

Original articles: general thoracic

Comparison of open and thoracoscopic bilateral volume reduction surgery: complications analysis

^a Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA

Address reprint requests to Dr Roberts, Department of Cardiac and Thoracic Surgery, 2986 The Vanderbilt Clinic, Nashville, TN 37232-5734
e-mail: (bob.roberts{at}mcmail.vanderbilt.edu)

Presented at the Forty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Naples, FL, Nov 6–8, 1997.

Background. The effectiveness of lung volume reduction for the treatment of patients with emphysema is well established, but data about the surgical approach, the postoperative management, and complications are limited. We report a comparison of patients undergoing bilateral lung volume reduction (BLVRS) via median sternotomy and thoracoscopic techniques with emphasis on hospital course and complications.

Methods. All patients undergoing BLVRS at Hospital of University of Pennsylvania were analyzed for mortality and morbidity, using a combination of prospective data analysis and retrospective chart review.

Results. Patients undergoing BLVRS via median sternotomy were older than those undergoing video-assisted thoracoscopic surgery (VATS) procedures (63.9 ± 6.89 vs 59.3 ± 9.4 years, p = 0.005). Operating time was longer for the VATS procedure (147 versus 129 minutes, p = 0.006) while estimated blood less was greater for median sternotomy (209 versus 82 L, p = 0.0000017).

Significant differences were found in intensive care unit stay, days intubated, life-threatening complications, respiratory complications, requirement for tracheostomy, and death that favored VATS BLVRS. When only later cohorts of patients were compared, more life-threatening complications and deaths were found in patients undergoing BLVRS by median sternotomy. There were no differences between early and late median sternotomy BLVRS patients. Twenty-six percent of the lethal complications in median sternotomy BLVRS patients were bowel perforations, equally divided between duodenal ulcers and colons.

Conclusions. Managing patients after BLVRS remains complex. Bilateral video-assisted volume reduction offers equivalent functional outcome with potentially decreased morbidity and mortality. Gastrointestinal perforations can complicate the management of these patients.

This article has been cited by other articles:

				M. E. Friscia, J. Zhu, J. W. Kolff, Z. Chen, L. R. Kaiser, C. S. Deutschman, and J. B. Shrager Cytokine Response is Lower After Lung Volume Reduction Through Bilateral Thoracoscopy Versus Sternotomy Ann. Thorac. Surg., January 1, 2007; 83(1): 252 - 256. [Abstract] [Full Text] [PDF]

				J. W. Klena, A. F. Saari, D. O. Peterson, C. Collins, and J. A. Johnson Combined video-assisted thoracoscopic lung volume reduction surgery and lobectomy in a high-risk patient Ann. Thorac. Surg., December 1, 2003; 76(6): 2079 - 2080. [Abstract] [Full Text] [PDF]

				I.F. Oey, D.A. Waller, S. Bal, S.J. Singh, T.J. Spyt, and M.D.L. Morgan Lung volume reduction surgery - a comparison of the long term outcome of unilateral vs. bilateral approaches Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 610 - 614. [Abstract] [Full Text] [PDF]

				G. R. Stirling, W. J. Babidge, M. J. Peacock, J. A. Smith, K. S. Matar, G. I. Snell, D. J. Colville, and G. J. Maddern Lung volume reduction surgery in emphysema: a systematic review Ann. Thorac. Surg., August 1, 2001; 72(2): 641 - 648. [Abstract] [Full Text] [PDF]

				K. S. Naunheim, S. R. Hazelrigg, L. R. Kaiser, R. J. Keenan, J. E. Bavaria, R. J. Landreneau, J. Osterloh, and C. A. Keller Risk analysis for thoracoscopic lung volume reduction: a multi-institutional experience Eur. J. Cardiothorac. Surg., June 1, 2000; 17(6): 673 - 679. [Abstract] [Full Text] [PDF]