Joseph B. Shrager.
University of Pennsylvania, Philadelphia, PA, USA.
OBJECTIVE: Two primary approaches to surgical Lung Volume Reduction (LVRS) have been reported: video-thoracoscopy (VATS) and Median Sternotomy (MS). We reviewed our experience to collect information on the pros/cons of the 2 approaches and to report upon techniques and "lessons learned."
METHODS: Retrospective review of a single-surgeon experience with LVRS.
RESULTS: Sixty-seven LVRS procedures were performed in a 9 year time-frame: twenty-seven via VATS, 35 via MS, and 5 via thoracotomy. All patients received a thoracic epidural catheter. 18/27 VATS procedures were bilateral, and 9/27 were unilateral. VATS evolved to a 3-port, non-triangulated technique with buttressing of staple lines. Due to concern that the magnification of VATS might lead to lesser volumes of lung resection, VATS has generally been reserved for the most compromised patients. Despite this, overall outcomes between VATS and MS were similar. Serum cytokines measured in a subset of 6 VATS and 9 MS patients demonstrated a lower stress response in the VATS group. One patient in the MS group required reoperation for persistent air leak. The single death occurred in the MS group.
CONCLUSIONS: VATS LVRS can be performed with negligible morbidity/mortality in carefully selected patients. Patient allocation to VATS or MS is ideally individualized by surgeons who are not biased toward one procedure or the other. Techniques that yielded these results will be reviewed.
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