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Eur J Cardiothorac Surg 1998;14:33-39
© 1998 Elsevier Science NL

Unilateral thoracoscopic reduction pneumoplasty for asymmetric emphysema¹

^a Department of Thoracic Surgery, Cattedra di Chirurgia Toracica e Cattedra di Radiologia, Università Tor Vergata di Roma, Tor Vergata University, Rome, Italy
^b Department of Radiology, Cattedra di Chirurgia Toracica e Cattedra di Radiologia, Università Tor Vergata di Roma, Tor Vergata University, Rome, Italy

Received 10 November 1997; received in revised form 9 March 1998; accepted 15 April 1998.

Corresponding author. Cattedra di Chirurgia Toracica, Università Tor vergata, Ospedale S. Eugenio, P. le Umanesimo 10, 00144 Rome, Italy. Tel.: +39 6 59042607; fax: +39 6 5922681; e-mail: mineo@utovrm.it

Objective: We prospectively analyzed the surgical and functional results of unilateral thoracoscopic reduction pneumoplasty which we performed by choice in patients with asymmetric emphysema. Methods: Between October 1995 and June 1997, 119 emphysematous patients were examined and 34 were operated upon. Among these, 14 selected patients with asymmetric distribution of emphysema in the lungs underwent unilateral reduction pneumoplasty (ten right, and four left). There were 13 males and one female, with a mean age of 62 years. Eligibility criteria included bullous and non-bullous end-stage emphysema with severe limitation to daily activity. Results: No patient required conversion to thoracotomy. Mean operative time ranged between 70 and 240 min with a mean of 103 min. There was no postoperative mortality but five patients developed one or more complications: five prolonged air leaks (>7 days); two pulmonary infections; one empyema. No patient required postoperative mechanical ventilation. Median hospital stay was 8 days. At the 3-month follow-up the mean FEV1 increased from 0.8 l to 1.2 l (P<0.001). Mean FVC increased from 2.6 l to 2.9 l (P<0.001). The Medical Research Council dyspnea score decreased from a mean of 3.2 to 1.8 (P<0.001). Conclusions: Asymmetric distribution is a frequent finding in patients with severe emphysema. Unilateral thoracoscopic reduction pneumoplasty may represent an ideal approach in this selected group of patients.

Key Words: Emphysema • Reduction pneumoplasty • Thoracoscopy

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