Single-stage, bilateral, video-assisted thoracoscopic lung volume reduction surgery for end-stage emphysema

The reintroduction of lung volume reduction surgery has provided functional improvement for selected patients afflicted with end-stage emphysema. Evolution of the operation from a median sternotomy approach to the two-stage video-assisted thoracoscopic surgical technique in our experience has resulted in a faster return to full activity. Nineteen patients underwent video-assisted thoracoscopic lung volume reduction surgery between July 1995 and August 1997. The 12 men and 7 women in the study had an average age of 63.7 years. All patients were evaluated preoperatively with computed tomography of the chest, radionuclide lung perfusion scan, left ventricular stress test, right heart catheterization, and a monitored rehabilitation program. In 15 patients the operation was performed as a bilateral single-stage procedure. The operation involved resection of wedges from the upper lobes and in 10 of these patients from the lower lobes as well. In all patients the estimated operative blood loss was less than 150 ml. The mean operative time was 177 minutes (range 115-235 minutes). The mean length of hospital stay was 10.8 days (median 11 days, range 5-24 days). At 2 to 3 months' follow-up increases were noted in the FEV1 (51%), PaO2 (27%), and 6-minute walk distance (18%); and there was a decrease in total lung capacity and respiratory volume. No significant change was observed in carbon monoxide diffusion in the lung. Morbidity included persistent air leaks in three patients and refractory supraventricular tachyarrhythmia in one. There were no perioperative deaths. We therefore recommend this technical modification to reduce operating time and blood loss without compromising surgical exposure or outcome.