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J Thorac Cardiovasc Surg 1996;112:319-327
© 1996 Mosby, Inc.

GENERAL THORACIC SURGERY

THORACOSCOPIC LASER BULLECTOMY: A PROSPECTIVE STUDY WITH THREE-MONTH RESULTS

Received for publication June 21, 1995 Revisions requested Jan. 18, 1996; revisions received April 15, 1996 Accepted for publication April 23, 1996. Address for reprints: Stephen R. Hazelrigg, MD, P.O. Box 19230, 800 N. Rutledge, Southern Illinois University, School of Medicine, Springfield, IL 62794-9230.

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. (J THORAC CARDIOVASC SURG 1996;112:319-27)

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