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Thoracoscopic lung volume reduction surgery for emphysema. Evaluation using ventilation-perfusion scintigraphy.
K Nezu1, K Kushibe, N Sawabata
1Department of Surgery III, Nara Medical University, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|August 3, 1999
Summary
Bilateral thoracoscopic lung volume reduction surgery significantly improves lung function and reduces dyspnea compared to unilateral procedures. This surgical approach is recommended for most patients, with scintigraphy aiding in patient selection and outcome assessment.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Medical Imaging
Background:
- Lung volume reduction surgery (LVRS) is a treatment option for severe emphysema.
- Assessing the efficacy of different LVRS approaches is crucial for patient management.
Purpose of the Study:
- To compare the short-term functional outcomes of bilateral versus unilateral thoracoscopic lung volume reduction surgery.
- To evaluate the utility of ventilation and perfusion scintigraphy in assessing LVRS outcomes.
Main Methods:
- 28 patients underwent thoracoscopic LVRS (21 bilateral, 7 unilateral).
- Procedures included stapler resection and Nd:YAG laser ablation.
- Ventilation and perfusion scintigraphy were performed pre- and post-surgery.
Main Results:
- Bilateral LVRS showed greater improvement in forced expiratory volume in 1 second (FEV1.0) (44%) compared to unilateral LVRS (17%).
- Improved lung perfusion/ventilation distribution and shortened mean transit time correlated with better dyspnea scores, FEV1.0, and VO2max.
- One operative death (3.6%) occurred following a simultaneous bilateral procedure.
Conclusions:
- Bilateral thoracoscopic LVRS offers superior short-term functional outcomes compared to unilateral LVRS.
- This procedure should be considered the primary surgical option for most eligible patients.
- Ventilation/perfusion scintigraphy is valuable for surgical planning and outcome evaluation in LVRS.