Abstract
There has been dramatic resurgence of interest in surgical treatment of emphysema, particularly "lung volume reduction" procedures. Recent studies have demonstrated improvements in pulmonary function, lung mechanics, exercise tolerance, and quality of life in selected patients following volume reduction procedures. However, considerable uncertainty remains regarding overall benefit, optimal patient selection, operative techniques, and duration of response. This summarizes current approaches to lung volume reduction surgery, available clinical outcome information, selection criteria, and physiologic mechanisms of response, and discusses the potential role for surgical volume reduction in treatment of emphysema. Recent data appear to support the efficacy of bilateral staple lung volume reduction surgery in patients with severe symptomatic heterogeneously distributed emphysema. Further studies will be needed to determine relative value of different operative techniques and benefit in patients with other clinical presentations.
Highlights
Free b eam laser treatment resulted in greater improvement in FEV1 than contact tip laser (18% vs 13%), it was still not as effective as unilateral staple procedures
Because both unilateral and bilateral lung volume reduction can a chieve many of the goals of surgical treatment of emphysema, McKenna et al[52] analyzed
Available data suggest that standard operation at this time for a patient with severe heterogeneous emphysema should be bilateral staple lung volume reduction procedures performed by either median sternotomy or video-assisted thoracic surgery (VATS)
Summary
The goal of the preoperative assessment process is to select patients with severely symptomatic disease who may benefit from surgery with an acceptable surgical risk. Routine evaluation for LVRS includes a complete medical history, physical examination, and other anatomic and physiologic evaluations. An algorithm describing this selection process used at Washington Universi~ Medical Center in St. Louis is shown in Figure 1.3 Some of the most important points in the decision tree are as follows: (1) predom-
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