Thoracoscopic laser bullectomy: a prospective study with three-month results.

Abstract

One hundred forty-one patients were prospectively enrolled in a study of contact-tip laser bullectomy at four institutions. Ninety-one have had both preoperative and postoperative testing at 3 months. Nonsmoking patients with disabling dyspnea at less than 50 yards and with a forced expiratory volume in 1 second of 35% or less were enrolled. Testing included formal pulmonary function tests, arterial blood gasses, computed tomographic scans, ventilation/perfusion scans, echocardiograms, electrocardiograms, 6-minute walk testing, transdiaphragmatic pressures, and quality of life and dyspnea index questionnaires. A modest 16% improvement was noted in forced expiratory volume in 1 second (0.69 to 0.80 L), and there was a 29% improvement in 6-minute walk distances (655.2 to 846.3 feet). Oxygen use was completely discontinued in 16%. Risk factors for mortality included age, 6-minute walk distances, low diffusing capacity for carbon monoxide, high carbon dioxide tension, and high base excess. Minor improvement was judged from the dyspnea index and the Medical Outcome Study Short Form-36. Preoperative predictors of good outcome included heterogeneous disease, lack of carbon dioxide retention, and no emaciation (weight < 40 kg). Comparison of our results with those in the literature suggests that the improvement seen with the contact neodymium:yttrium-aluminum-garnet laser is not as good as that provided by the stapled techniques for volume reduction.

• Authors: S Hazelrigg, T Boley, J Henkle, C Lawyer, D Johnstone, K Naunheim, C Keller, R Keenan, R Landreneau, F Sciurba, R Feins, P Levy, M Magee
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 112 Issue 2 Pg. 319-26; discussion 326-7 (Aug 1996) ISSN: 0022-5223 [Print] United States
• PMID: 8751498 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Carbon Dioxide
• Carbon Monoxide
• Oxygen

Topics

• Acid-Base Imbalance (blood)
• Adult
• Aged
• Blister (surgery)
• Carbon Dioxide (blood)
• Carbon Monoxide
• Dyspnea (surgery)
• Echocardiography
• Electrocardiography
• Endoscopy
• Exercise Test
• Follow-Up Studies
• Forced Expiratory Volume
• Humans
• Laser Therapy
• Lung Diseases (surgery)
• Middle Aged
• Oxygen (blood)
• Oxygen Inhalation Therapy
• Pressure
• Prospective Studies
• Pulmonary Diffusing Capacity
• Quality of Life
• Risk Factors
• Thoracoscopy
• Tomography, X-Ray Computed
• Treatment Outcome
• Ventilation-Perfusion Ratio