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Related Experiment Videos

Bilateral apical vs nonapical stapling resection during lung volume reduction surgery

J M Travaline1, S Furukawa, A M Kuzma

  • 1Division of Pulmonary and Critical Care Medicine, and Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA.

Chest
|October 29, 1998
PubMed
Summary

Lung volume reduction surgery (LVRS) using either biapical or nonapical resection yields comparable improvements in lung function and quality of life. Both surgical approaches demonstrate similar morbidity and mortality rates in patients with severe emphysema.

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Area of Science:

  • Pulmonary Medicine
  • Thoracic Surgery
  • Respiratory Physiology

Background:

  • Severe emphysema significantly impairs lung function and quality of life.
  • Lung volume reduction surgery (LVRS) is a treatment option for severe emphysema.
  • The optimal surgical approach for LVRS, specifically biapical versus nonapical resection, requires further investigation regarding its impact on outcomes.

Purpose of the Study:

  • To compare the physiologic outcomes, morbidity, and mortality between biapical stapling resection and nonapical resection in LVRS.
  • To determine if LVRS targeting specific diseased areas offers advantages over standard biapical resection.

Main Methods:

  • A consecutive case-series analysis was conducted at an urban university hospital.
  • Forty-seven patients with severe emphysema underwent either biapical (n=32) or nonapical (n=15) LVRS via median sternotomy or VATS.

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  • Patients were assessed preoperatively and at 3 months postoperatively for spirometry, lung volumes, gas exchange, exercise capacity (6-min walk distance), diaphragm strength, quality of life, and complications.

    • Main Results:

    • Both biapical and nonapical LVRS groups showed similar baseline characteristics and resected tissue weights.
    • At 3 months post-LVRS, both groups experienced comparable improvements in 6-min walk distance, FEV1, lung volumes, and quality of life.
    • Hospital length of stay, duration of air leak, and complication rates (respiratory infections, reintubation, reoperation, death) were similar between the biapical and nonapical resection groups.

    Conclusions:

    • LVRS, whether performed via biapical or nonapical resection, results in similar improvements in lung function, exercise capacity, and quality of life.
    • The choice between biapical and nonapical resection for LVRS does not significantly alter morbidity or mortality.
    • Nonapical resection of diseased lung areas provides comparable outcomes to standard biapical resection in LVRS.