This study was conducted to investigate the correlation of thoracoscopic
lung volume reduction to changes in pulmonary function and exercise performance in patients with
pulmonary emphysema. Unilateral thoracoscopic
lung volume reduction treatment was performed in 30 patients with severe
pulmonary emphysema. If large
bullae were present, they were excised using an endoscopic stapling device, and the emphysematous pleura was contracted by
neodymium:
yttrium-
aluminium-garnet
laser to reduce the volume of nonfunctional lung air space. Pulmonary function and incremental exercise tests were performed before and at least 3 months
after treatment. Follow-up functional evaluation showed a highly significant improvement in the forced expiratory volume in 1s (FEV1), forced vital capacity, static compliance, and maximal
oxygen uptake. The functional residual capacity as measured by the gas dilution method (FRCgas), was unchanged; however, it was found to be decreased significantly when measured by body plethysmograph (FRCbox). Positive correlations existed between the reduction in FRCbox and the increase in FEV1 (r = 0.586, P = 0.0042) and maximal
oxygen uptake (r = 0.550, P = 0.018). Pulmonary ventilation and exercise ability in patients with
pulmonary emphysema were improved in a volume-dependent manner by thoracoscopic
lung volume reduction. These findings indicate that patients with a preoperative trapped gas volume level exceeding 11 would be ideal candidates for thoracoscopic
lung volume reduction.