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Ann Thorac Surg 2000;69:1670-1674
© 2000 The Society of Thoracic Surgeons

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Original articles: General thoracic

Comparison of clinical results for unilateral and bilateral thoracoscopic lung volume reduction

^a Division of Cardiothoracic Surgery, Saint Louis University, St. Louis, Missouri, USA
^b Division of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
^c Division of Cardiothoracic Surgery, Allegheny University, Pittsburgh, Pennsylvania, USA
^d Division of Cardiothoracic Surgery, Southern Illinois University, Springfield, Illinois, USA
^e Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Address reprint requests to Dr Naunheim, Department of Surgery, Saint Louis University Health Sciences Center 3635 Vista Ave at Grand Blvd, PO Box 15250, St. Louis, MO 63110–0250
e-mail: naunheks{at}slu.edu

Presented at the Forty-sixth Annual Meeting of the Southern Thoracic Surgical Association, San Juan, Puerto Rico, Nov 4–6, 1999.

Background. It is widely believed that bilateral thoracoscopic lung volume reduction (BTLVR) yields superior results when compared with unilateral thoracoscopic lung volume reduction (UTLVR) with regard to spirometry, functional capacity, oxygenation and quality of life results.

Methods. To address these issues, we compared the results of patients undergoing UTLVR (N = 338 patients) and BTLVR (N = 344 patients) from 1993 to 1998 at five institutions. Follow-up data were available on 671 patients (98.4%) between 6 and 12 months after surgery, and a patient self-assessment was obtained at a mean of 24 months.

Results. It was found that BTLVR provides superior improvement in measured postoperative percent change in FEV₁ (L) (UTLVR 23.3% ± 55.3 vs BTLVR 33% ± 41, p = 0.04), FVC(L) (10.5% ± 31.6 vs 20.3% ± 34.3, p = 0.002) and RV(L) (-13% ± -22 vs -22% ± 17.9, p = 0.015). BTLVR also provides a slight improvement over UTLVR in patient’s perception regarding improved quality of life (UTLVR 79% vs BTLVR 88%, p = 0.03) and dyspnea relief (71% vs 61%, p = 0.03). There was no difference in mean changes in PO₂ (mm Hg) (UTLV 4.5 ± 12.3 vs BTLVR 4.9 ± 13.3, p = NS), 6-minute walk (UTLVR 26% ± 66.1 vs BTLVR 31% ± 59.6, p = NS) or decreased oxygen utilization (UTLVR 78% vs BTLVR 74%, p = NS).

Conclusions. These data suggest that both UTLVR and BTLVR yield significant improvement, but the results of BTLVR seem to be superior with regard to spirometry, lung volumes, and quality of life.

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Discussion
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