Thoracoscopic laser pneumoplasty in the treatment of diffuse bullous emphysema.
BACKGROUND
Thoracoscopic laser pneumoplasty in the treatment of diffuse bullous emphysema by means of a contact neodymium:yttrium-aluminum garnet laser was evaluated by a retrospective analysis of the first consecutive 500 procedures in 443 patients. The indication for thoracoscopic laser pneumoplasty was intractable dyspnea.


METHODS
Advanced age (mean age, 67 years), high oxygen dependency (70%), steroid use (46%), and markedly diminished physical capacity (2% bedridden and 27% wheelchair-bound) were noted. Thoracoscopic laser pneumoplasty was carried out under general anesthesia and one-lung ventilation. Type 3 bullae (381 procedures) were contracted by contact neodymium:yttrium-aluminum garnet laser and type 4 bullae (199 procedures) excised. The operative mortality rate was 4.8%.


RESULTS
Subjective improvement was reported by 87% of the patients. Follow-up functional evaluation was available in 229 patients, which showed highly significant improvement. A comparison of preoperative and postoperative functional tests between type 3 and 4 bullae patients showed no significant difference, except the latter had higher decrease in airway resistance, residual volume, and total lung capacity.


CONCLUSIONS
Thoracoscopic laser pneumoplasty is an effective treatment for both type 3 and 4 bullous emphysema with an acceptable risk.
Wakabayashi
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Wakabayashi Institute at Irvine Medical Center, California 92718, USA.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009354:Neodymium; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D015656:Respiratory Mechanics; D012189:Retrospective Studies; D013906:Thoracoscopy; D016896:Treatment Outcome; D015019:Yttrium
D009354:Neodymium; D015019:Yttrium