Unilateral video-assisted thoracic surgical lung reduction

Background. Lung reduction has been demonstrated to be a promising treatment for end-stage emphysema when performed on both lungs via sternotomy. The role for a thoracoscopic approach has not yet been determined. Methods. Unilateral video-assisted thoracic surgical lung reduction was performed on 50 patients for the treatment of end-stage emphysema. There were 34 men and 16 women with a mean age of 61.5 years (range, 31 to 78 years). Emphysema was secondary to smoking in 45 patients (90%), and α1-antitrypsin deficiency in 5 patients (10%), 4 of whom had smoked in the past. Lung reduction was performed unilaterally using a thoracoscope and a stapled resection without the routine use of bovine pericardium. The side to be operated on the site of resection were determined preoperatively by examination of the perfusion and computed tomographic scans of the lungs. The average amount of lung removed was 59 ± 15 g (range, 29 to 111 g). Results. Morbidity included prolonged air leak in 15 patients (30%), bleeding in 3 (6%), pneumonia requiring reintubation in 3 (6%), myocardial infarction in 1 (2%), and perforated ulcer in 1 (2%). Seven patients (14%) required a second thoracic procedure for management of these complications. Two patients died, for an operative mortality of 4%. Follow-up obtained between 1 and 3 months in 25 patients revealed significant improvement in forced expiratory volume in 1 second (0.71 to 0.95 L; p < 0.001), forced vital capacity (2.24 to 2.58 L; p < 0.01), and oxygen tension (59 to 67 mm Hg; p < 0.01). The improvement in functional capacity as measured by 6-minute walk approached statistical significance (771 to 923 ft; p = 0.06). Conclusions. Significant subjective improvement in dyspnea has been noted in 41 of 48 hospital survivors (85%). For patients with end-stage emphysema, unilateral video-assisted thoracic surgical lung reduction appears to be a preferable alterantive to standard medical management.