Improved results of lung volume reduction surgery with evolution of operative technique

Purpose: Lung volume reduction surgery (LVRS) has been reintroduced in the management of patients with end-stage lung disease secondary to emphysema. From October 1994 through March 1996, 110 consecutive patients underwent bilateral LVRS via median sternotomy approach utilizing mechanical stapling devices, bovine pericardial strip, and single lung anesthesia. We hypothesize that improvements in operative technique have reduced operative cost, morbidity, and mortality after LVRS. Methods: The initial 35 patients (MWTS) underwent multiple wedge excisions of the lung and chest tubes were placed on 10 cm of suction in the operating room. The next 40 patients (SWTS) underwent single continuous wedge excision of the lung and chest tubes were also placed on 10 cm of suction. The last 35 patients (SWNS) also underwent single wedge excision of each lung, but the chest tubes were placed on no suction (H₂O seal). (*=p<0.05) Results: MWTS SWTS SWNS Airleaks>7 days 20 12* 3* (# of patients) Procedure cost 5410 2550* 2510* (median dollars) Hospital stay 19.1 13.5* 9.1* (median # of days) Operative mortality 6 2* 0* (# of patients) Conclusion: These data support our clinical impression that the use of a single continuous wedge excision of the lung and no chest tube suction resulted in statistically significant reduction in operative costs, morbidity, and mortality in patients undergoing LVRS for emphysema at our institution.