Evaluation of respiratory muscle strength by randomized controlled trial comparing thoracoscopy, transaxillary thoracotomy, and posterolateral thoracotomy for lung biopsy.
OBJECTIVE
The aim of this study was to demonstrate that the postoperative recovery of respiratory muscle strength is better in patients who undergo video-thoracoscopy than in patients who undergo transaxillary thoracotomy or posterolateral thoracotomy.


METHODS
Randomized controlled trial with three parallel groups.


METHODS
Eligible patients had undergone wedge resection for lung biopsy in interstitial lung disease or in pulmonary nodule. Twenty-four patients were randomly assigned to one of the three thoracic procedures: eight in the video-thoracoscopy (VT) group, eight in the transaxillary thoracotomy (TT) group, and eight in the posterolateral thoracotomy (PLT) group.


METHODS
The postoperative respiratory muscle strength was assessed by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measured by mouth pressure. Measurements were made the day before the operation and 2, 4, and 30 days after the operation. Changes in postoperative MIP and MEP were expressed as a percentage of preoperative values.


RESULTS
The three groups were comparable with respect to age, gender, comorbidity, preoperative spirometry, preoperative MIP, MEP and peak flow, and volume of lung tissue. At 2, 4, and 30 days after the operation, mean MIP were, respectively, 111+/-22%, 119+/-22%, and 124+/-22% in the VT group, 76+/-22%, 109+/-22%, and 127+/-22% in the TT group, and 51+/-22%, 50+/-22%, and 77+/-22% in the PLT group (p<0.0001). At 2, 4, and 30 days after the operation, mean MEP were, respectively, 94+/-15%, 103+/-15%, and 105+/-15% in the VT group, 61+/-15%, 98+/-15%, and 126+/-15% in the TT group, and 62+/-15%, 75+/-15%, and 87+/-15% in the PLT group (p<0.05).


CONCLUSIONS
Video-thoracoscopy allows better recovery of respiratory muscle function after surgery than posterolateral thoracotomy. However, at 4 and 30 days after surgery, video-thoracoscopy and transaxillary thoracotomy gave similar results of impairment of respiratory muscle strength.
Bernard
Alain
A
Department of General Thoracic Surgery, Centre Hospitalier Universitaire Hôpital du Bocage, Bd de Lattre de Tassigny, 21034 Dijon Cedex, France. alain.bernard@chu-dijon.fr
Brondel
Laurent
L
Arnal
Eric
E
Favre
Jean-Pierre
JP
D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008171:Lung Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D020127:Recovery of Function; D015656:Respiratory Mechanics; D012132:Respiratory Muscles / Q000503:physiopathology*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods