Thoracoscopic Lung Volume Reduction Research Articles

Quasilobar minimalist lung volume reduction surgery.

Our goal was to assess the results and the costs of the quasilobar minimalist (QLM) thoracoscopic lung volume reduction (LVR) surgical method developed to minimize the trauma from the operation and the anaesthesia and to maximize the effect of the lobar volume reduction. Forty patients with severe emphysema underwent QLM-LVR that entailed adoption of sole intercostal block analgesia and lobar plication through a single thoracoscopic incision. Results were compared after propensity matching with 2 control groups undergoing non-awake resectional LVR with double-lumen tracheal intubation or awake non-resectional LVR by plication with thoracic epidural anaesthesia. As a result, we had 3 matched groups of 30 patients each. Baseline forced expiratory volume in 1 s, residual volume, the 6-min walking test and the modified Medical Research Council dyspnoea index were 0.77 ± 0.18, 4.97 ± 0.6, 328 ± 65 and 3.3 ± 0.7, respectively, with no intergroup difference after propensity score matching. The visual pain score was better (P < 0.007), the hospital stay was shorter (P < 0.04) and overall costs were lower (P < 0.04) in the QLM-LVR group than in the control groups. The morbidity rate was lower with QLM-LVR than with non-awake resectional-LVR (P = 0.006). Significant improvements (P < 0.001) occurred in all study groups during the follow-up period. At 24 months, improvements in residual volume and dyspnoea index were significantly better with QLM-LVR (P < 0.04). QLM-LVR proved safe and showed better perioperative outcomes and lower procedure-related costs than the control groups. Similar clinical benefit occurred at 12 months, but absolute improvements in residual volume and dyspnoea index were better in the QLM-LVR group at 24 months.

Rare cause of emphysema

A 52-year-old man with chronic obstructive pulmonary disease GOLD 4, group D, and severe, heterogeneous pulmonary emphysema (figure 1) and marked hyperinflation was treated with bronchoscopic lung volume reduction (LVR)...

Successful lung volume reduction surgery in combined pulmonary emphysema and fibrosis without body-plethysmographic hyperinflation—a case report

Surgical and bronchoscopic lung volume reduction (LVR) have been demonstrated to improve lung function, dyspnea and quality of life in patients with severe pulmonary emphysema. The most important functional prerequisite for a successful LVR is hyperinflation measured by body plethysmography. A residual volume (RV) of more than 180% predicted and a RV/total lung capacity (TLC) ratio of more than 0.58 were inclusion criteria in major LVR trials. Here we report a successful LVR in a 68-year-old man with advanced, heterogeneous emphysema without plethysmographic evidence of severe hyperinflation (RV/TLC 0.45). Computed tomography (CT) revealed severe, partly bullous upper lobe emphysema and subtle fibrotic changes with volume loss of lower lobes. Since lower lobes appeared compressed by upper lobe emphysema, these target areas were removed by thoracoscopic LVR. Four months later, the patient reported major improvements of dyspnea, FEV1 (by 1.27 L) and 6-minute walking distance (by 150 meters). LVR reduced total lung volume measured by CT-volumetry by 0.5 L and upper lobe volume by 1.85 L while lower lobe volume increased by +1.34 L. Low density volume (-950 HU) reflecting emphysema was reduced by 1.73 L. We conclude that the opposing effects of emphysema and fibrosis resulted in a barely increase in total lung volume that was only slightly reduced by LVR. Nevertheless, resection of emphysematous target areas identified by quantitative CT analysis provided major clinical and physiologic improvements related to decompression of low-compliance lower lobe areas retracted by early fibrosis. Therefore, in the combined presence of severe, heterogeneously distributed emphysema and fibrosis, LVR may improve respiratory mechanics even if RV/TLC, an established body-plethysmographic predictor of LVR success is not severely elevated.

Nonintubated Subxiphoid Bilateral Redo Lung Volume Reduction Surgery

This report describes a nonintubated, bilateral thoracoscopic redo lung volume reduction surgery procedure through a single subxiphoid access in a patient who previously underwent one-stage bilateral volume reduction for upper lobe-predominant heterogeneous emphysema 19 years earlier. The patient was uneventfully discharged on postoperative day 2, and meaningful improvement in respiratory function and exercise tolerance occurred at 3 months postoperatively. This novel surgical approach may merge the potential benefits of a subxiphoid incision for bilateral treatment, nonintercostal passage of chest drains, and adoption of a nonintubated anesthesia protocol.

Staged bilateral single-port thoracoscopic lung volume reduction surgery: A report of 11 cases.

The aim of the present study was to investigate the feasibility and efficacy of staged bilateral single-port thoracoscopic lung volume reduction surgery (LVRS) for patients with chronic obstructive pulmonary emphysema (COPE). Eleven male patients with a mean age of 60.27±12.11 years with bilateral COPE and bullae were admitted to the Department of Thoracic Surgery, Xuzhou Central Hospital from January 2013 to June 2014. The patients underwent staged bilateral single-port thoracoscopic LVRS. The hyperinflated bullae were resected using endoscopic staplers (Endo-GIA), followed by continuous suture and biological glue for reinforcement of the margin. In addition, pulmonary function, blood gas assay, 6-min walk distance (6MWD) and life quality evaluated by a short form 36-item health survey questionnaire (SF-36) were recorded before and after LVRS, respectively. All the patients survived after surgery. The chest tube drainage time was 9.09±1.31 days and postoperative hospital stay was 15.73±2.75 days, with 5 cases of persistent air leakage and 7 cases of pulmonary infection which were finally cured. The patients were followed up for 3 to 12 months, and the pulmonary function, partial pressure of oxygen (pO2), 6MWD and life quality after unilateral or bilateral LVRS were improved compared to these parameters before surgery. However, there was no significant difference between unilateral and bilateral LVRS in terms of life quality. In conclusion, staged bilateral single-port thoracoscopic LVRS may improve the short-term life quality of patients with COPE.

Video Assisted Thoracoscopic Surgery Lung Volume Reduction for Chronic Obstructive Pulmonary Disease in Indonesia

Chronic Obstructive Pulmonary Disease (COPD) in the future will be increased according to increasing air pollution by smoke from factories or vehicles and smoking habits. Asthma, chronic bronchitis, bronchiectasis, emphysema and others chronic and critical conditions require minimal invasive surgery.

Multisite drainage of recalcitrant subcutaneous emphysema in thoracoscopic lung volume–reduction surgery

Subcutaneous emphysema can develop after lung volume– reduction surgery in the presence of major, nonsealable air leaks. Although this condition is nonlethal, it can cause cosmetic deformity, anxiety, change in voice, vision problems, dysphagia, tension phenomena, and even respiratory failure. In the most severe instances (recalcitrant subcutaneous emphysema), standard management, including the application of as much as 40 cm H2O suction to the chest tube often proves unsatisfactory and additional drainage methods or reoperation have been anecdotally advocated to achieve decompression. I report here a novel multisite subcutaneous drainage method that has been successfully used at my institution to treat recalcitrant subcutaneous emphysema occurring after thoracoscopic lung volume–reduction surgery.

Latissimus Dorsi Myoclonus After Video Assisted Thoracoscopic Lung Volume Reduction

Myoclonus as a sequel to thoracotomy has been reported, and its treatment can be challenging to both the patient and the surgeon. We describe a 43-year-old patient with chest wall pain and latissimus dorsi muscle contractions (myoclonus) after video-assisted thoracoscopic lung volume reduction. His symptoms remained refractory to benzodiazepines, nerve blockage, and botulinum toxin injection due to either poor compliance or lack of response to therapy. These symptoms started to resolve spontaneously 18 months after the procedure.

Spontaneous bronchopleural fistula following lung volume reduction surgery for emphysema

Five days following bilateral thoracoscopic lung volume reduction surgery for emphysema, a 63-year-old man underwent reoperation for closure of a massive bronchopleural fistula. It was discovered intraoperatively that the fistula was located distant from prior staple lines or resection sites from his surgery. This case is an example of what may be a unique pathophysiologic mechanism of bronchopleural fistula formation--a 'stress rupture' of the lung parenchyma following lung volume reduction surgery.

Persistent Benefit From Lung Volume Reduction Surgery in Patients With Homogeneous Emphysema

The purpose of this study was to evaluate whether favorable short-term results achieved by lung volume reduction surgery in selected patients with homogeneous emphysema would persist for longer periods. Their symptoms, lung function, and survival for several years were analyzed in comparison to patients with heterogeneous emphysema. Two hundred fifty consecutive patients (105 women), mean (+/- standard deviation) age 64 +/- 8.4 years, with advanced emphysema underwent bilateral thoracoscopic lung volume reduction surgery. Forced expiratory volume in 1 second was 28% +/- 8% of predicted, 6-minute walking distance was 245 +/- 118 m, and Medical Research Council dyspnea score was 3.5 +/- 0.7. In 138 patients (55%) computed tomography revealed homogeneous emphysema (including 82 intermediate type) distribution and in 112 patients (45%) heterogeneous emphysema. Baseline characteristics were otherwise similar in the two groups that were prospectively observed for several years. Thirty-day mortality was 2.4%. Both groups revealed significant improvements 3 months after lung volume reduction surgery: in homogeneous emphysema, predicted forced expiratory volume in 1 second was 38% +/- 14% (35% improvement), 6-minute walk distance was 324 +/- 87 m, and dyspnea score was 1.8 +/- 0.9 (p < 0.05 all outcomes). Corresponding results in heterogeneous emphysema were 44% +/- 15% (61% improvement), 382 +/- 95 m, and 1.3 +/- 0.9 points (p < 0.05 versus baseline; not significant versus homogeneous). Median time until predicted forced expiratory volume in 1 second and 6-minute walk distance had returned to baseline was 36 months in both groups. One-year survival was similar in both groups. At 5 years, median survival without lung transplantation was 64% in the homogeneous and 73% in the heterogeneous group (Cox proportional hazard, 0.81; 95% confidence interval, 0.66 to 0.98; p = 0.03). In selected patients with homogeneous pulmonary emphysema, lung volume reduction surgery can be successfully performed with low perioperative mortality. Significant improvements in dyspnea, lung function, and exercise capacity are maintained for several years.

Autologous fibrin sealant reduces the incidence of prolonged air leak and duration of chest tube drainage after lung volume reduction surgery: A prospective randomized blinded study

Prolonged air leak is reported in up to 50% of patients after lung volume reduction surgery. The effect of an autologous fibrin sealant on the intensity and duration of air leak and on the time to chest drain removal after lung volume reduction surgery was investigated in a randomized prospective clinical trial. Twenty-five patients underwent bilateral thoracoscopic lung volume reduction surgery. In each patient, an autologous fibrin sealant was applied along the staple lines on one side, whereas no additional measure was taken on the other side. Randomization of treatment was performed at the end of the resection on the first side. Air leak was assessed semiquantitatively by use of a severity score (0 = no leak; 4 = continuous severe leak) by two investigators blinded to the treatment. Mean value of the total severity scores for the first 48 hours postoperative was significantly lower in the treated group (4.7 +/- 7.7) than in the control group (16.0 +/- 10.1) (P < .001), independently of the length of the resection. Prolonged air leak and mean duration of drainage were also significantly reduced after application of the sealant (4.5% and 2.8 +/- 1.9 days versus 31.8% and 5.9 +/- 2.9 days) (P = .03 and P < .001). Autologous fibrin sealant for reinforcement of the staple lines after lung volume reduction surgery significantly reduces prolonged air leak and duration of chest tube drainage.

SPREADING THE BENEFIT OF LUNG VOLUME REDUCTION SURGERY: ONE STAGE BILATERAL VERSUS A STAGED UNILATERAL APPROACH DETERMINED BY THE PATIENT

PURPOSE: Having demonstrated the comparative benefits of unilateral over bilateral video assisted thoracoscopic lung volume reduction surgery (VAT LVRS) it is now our policy to perform two-stage bilateral LVRS. The timing of the second operation is determined by the patients’ perception of their symptoms. We wished to determine whether this policy would result in a more sustained improvement in postoperative benefits.

Chronic Cough in a Postpneumonectomy Patient

Abstract: A rare complication of pneumonectomy for pulmonarycarcinoma in a 70-year-old man is presented. Metallic clips fromstaple cartridges migrated from the periphery of the stump toward theairway lumen producing chronic, persistent cough 3 years after sur-gery. The clinical, diagnostic, and therapeutic implications of thiscondition, which most often is encountered by pulmonologists, arediscussed and the literature on this topic is reviewed. Key Words: chronic cough, pneumonectomy, staple cartridges( J Bronchol 2004;11:273–274) A lthough seldom reported, 1 endobronchial migration of su-turesorstaplesafterthoracotomycancausechroniccoughand/orhemoptysis,actingasnonaspiratedforeignbodiesinthebronchi. 2,3 Duringthelastdecade,fewreportshavebeenmadeon endobronchial sutures causing symptoms after lobectomy 4 or after thoracoscopic lung volume reduction surgery (LVRS),in which expulsion of metal clips (metalloptysis) was also re-ported. 5,6 In most cases, the final diagnosis was delayed andtreating physicians misled, erroneously attributing symptomsto chronic obstructive lung disease or to a possible recurrenceof the original tumor.

Long-term results after lung volume reduction surgery in patients with α1-antitrypsin deficiency

BackgroundThe favorable effects of lung volume reduction surgery for selected patients with smoker's emphysema has been demonstrated. However, outcome data for patients with α1-antitrypsin deficiency emphysema are scarce. MethodsWe prospectively studied pulmonary function, dyspnea, and 6-minute walking distance in 21 patients with severe α1-antitrypsin deficiency emphysema (PiZZ 18, PiZO 1, PiSZ 2, 10 female patients, median age 56 years, range 38-74 years) for as long as 5 years after thoracoscopic lung volume reduction surgery. ResultsLung volume reduction surgery improved the mean dyspnea score, from 3.7 ± 0.1 preoperatively to 1.4 ± 0.2 at 3 months; the score remained improved for as long as 3.5 years. Mean vital capacity (% predicted) improved from 79% ± 4.4% to 98% ± 4.8% at 3 months, and the ratio of residual volume to total lung capacity decreased from 0.67 to 0.51. These improvements lasted for as long as 2 years. The mean airflow obstruction (forced expiratory volume in 1 second % predicted) improved from 27% ± 1.9% to 38% ± 3.3% at 3 months and remained statistically improved for 1 year. Four patients showed long-term improvement in lung function for as long as 3.5 years. These patients had markedly heterogeneous emphysema and showed no radiologic signs of airway inflammation. ConclusionsLung volume reduction surgery in patients with advanced emphysema from α1-antitrypsin deficiency results in a significant improvement in dyspnea and lung function for as long as 3.5 years in some cases. It appears that magnitude and duration of these effects are inferior and shorter than those in patients with pure smoker's emphysema. Patients with heterogeneous disease and no or minor inflammatory airway disease may benefit most.

Combined video-assisted thoracoscopic lung volume reduction surgery and lobectomy in a high-risk patient

Nonsmall cell lung cancer often occurs in patients with severe emphysema. Lobectomy in these patients is often contraindicated due to extensive parenchymal destruction and subsequent pulmonary insufficiency. Video-assisted thoracoscopic lobectomy has been described as a less morbid procedure in high-risk patients. Lung volume reduction surgery has been shown to improve pulmonary function in selected patients with emphysema. We describe the successful combination of lobectomy and lung volume reduction surgery (LVRS) with a video-assisted thoracoscopic (VATS) approach in a high-risk patient with Stage I nonsmall cell lung cancer.

Postoperative pain detracts from early health status improvement seen after video-assisted thoracoscopic lung volume reduction surgery.

To assess the impact of lung volume reduction surgery (LVRS) on postoperative pain. Fifty-two patients, 34 male/18 female, median age 59 (46-70) years, underwent unilateral video-assisted thoracoscopic (VAT) LVRS. FEV(1), TLC, RV and RV/TLC ratio were assessed preoperatively and at 3, 6, 12 and 24 months post surgery. At the same time interval health status was assessed by Euroquol and SF 36 questionnaires. Significant improvements in health status, as assessed by SF 36, persisted from 3 months to 1 year. However, in the pain domain there was a worsening of the mean score from 74 preoperatively to 64 at 3 months, 68 at 6 months, 73 at 12 months and 65 at 24 months. The improvements in Euroquol score were not statistically significant. However, they became significant for at least 2 years postoperatively, when those patients who had a worsening pain score postoperatively were excluded. While the percentage of patients with a worsening of pain scores measured with SF 36 remained between 40 and 45% even 2 years after LVRS, when using Euroquol this percentage did decrease from 30% at 3 months to 14% at 2 years. There was no significant correlation between the change of scores and length of operation, hospital stay or air leak. It was also not statistically significant whether these patients had an extra procedure (redo thoracotomy or insertion of extra drain postoperatively). There were some significant correlations between changes in hyperinflation and changes in pain scores but this was not consistent for Euroquol and SF 36. Postoperative pain detracts from global improvement in health status after LVRS even after unilateral VATS. There may be an influence of alterations in chest mechanics after surgery on the development of pain.

Use of autologous pleural flap buttress in thoracoscopic lung volume reduction surgery

staple line after resection of the emphysematous lung has been a major complication after LVRS. 1 Several techniques, with fibrin glue, bovine pericardial strip buttressing, 3 fold plication, 4 or polyglycolic acid felt buttressing, 5 have been developed to prevent this postoperative air leakage. Although these techniques substantially reduce major, prolonged, or both air leakages, disadvantages include incorporation of foreign materials and cost. We have recently developed a new technique using an autologous pleural flap to buttress the staple line. The new procedure is simple, effective, and cost free, and it might enhance pleural adhesion after surgical intervention. Clinical Summary A 62-year-old man who had been a heavy smoker (one pack per day for 50 years) had progressive exertional dyspnea for 5 years before admission. Chronic obstructive pulmonary disease was diagnosed on the basis of chest radiography and spirometry examination. Despite regular use of oral and inhalational bronchodilators and oral prednisolone at the outpatient clinic, the dyspnea symptoms had worsened. After admission, the functional class was assessed as World Health Organization class III, and the patient was mostly confined to bed with nasal oxygen support. The spirometry study revealed a forced vital capacity of 2.52 L (82.3%), a forced expiratory volume in 1 second (FEV1.0) of 0.69 L (28.3%), a percent FEV1.0 of 27.4%, a residual volume of 3.7 L (236.3%), a total lung capacity of 6.4 L (137.4%), and a maximum voluntary ventilation of 17.9 L/min (22.8%). Diffusion capacity was 8.7 mL · min 1 ·m m Hg 1 (47.6%). The pulmonary exercise maximum oxygen consumption was 13.1 mL · min 1 kg 1 (43.3%). Chest computed tomography showed diffuse emphysematous changes with bulla formation, which was more severe on the bilateral upper lobes. Ventilation scans revealed heterogenous tracer ventilation in bilateral lung fields, and arterial blood gas on room air was pH 7.39, PaO2 was 78.5 mm Hg, PaCO2 was 38.5 mm Hg, and HCO3 was 22.8 mEq/L. The patient was deemed a good candidate for LVRS, with the new technique subsequently used during the operation. LVRS was performed by the bilateral thoracoscopic approach. First, a left-sided double-lumen tube was inserted to provide unilateral lung collapse during the thoracoscopic procedure. The patient was placed in the true lateral position, with his right side upward. A camera port (1 cm) was first made in the ninth intercostal space (ICS) along the midaxillar line. After inspection of lung pathology, a 3-cm working port was made in the third ICS in the midsubaxillar area, without entrance into the parietal pleura. Another 1-cm working port was made subsequently in the fifth ICS along the anterior-axillar line. Blunt dissection was commenced on the first working port, with the dissection plane between the parietal pleura and chest wall. Dissection of a large flap of parietal pleura was very simple because the interior between the parietal pleura and chest wall consisted only of areolar tissue (Figure 1, a). The area of dissection was anterior to the mediastinum, posterior to the paraspinal area, and extended downward to the fifth ICS, which was carefully preceded to avoid injury to the sympathetic trunk and intercostal vessels. Subsequently, a pleural flap

Lung volume reduction surgery and nutritional status in patients with severe emphysema.

We studied the short-term effect of lung volume reduction surgery on nutritional status including body composition and the relationship between preoperative nutritional status and postoperative morbidity. Subjects were 28 patients with emphysema who underwent bilateral thoracoscopic lung volume reduction surgery (23 simultaneously, 5 staged). Functional tests, body weight, and body composition were measured before and 6 months after surgery. Fat-free mass and fat mass were assessed by bioelectrical impedance analysis. FEV1.0 improved 35.2% following surgery and maximal oxygen uptake 23.8%. Body weight and fat-free mass increased significantly after surgery, while fat mass was unchanged. Of the 23 undergoing simultaneous bilateral lung volume reduction surgery, 8 had major complications-3 required additional surgery to close air leaks, 3 required mechanical ventilation (> 72 hrs), and 2 developed postoperative infection. The preoperative percentage of ideal body weight and fat-free mass was significantly higher among patients without major complications. Bilateral lung volume reduction surgery increases fat-free mass and provides functional improvement for underweight patients with severe emphysema. We found fat-free mass and body weight to be good predictors of unacceptable postoperative complications following bilateral lung volume reduction surgery.

Comparison of clinical results for unilateral and bilateral thoracoscopic lung volume reduction

Background. It is widely believed that bilateral thoracoscopic lung volume reduction (BTLVR) yields superior results when compared with unilateral thoracoscopic lung volume reduction (UTLVR) with regard to spirometry, functional capacity, oxygenation and quality of life results. Methods. To address these issues, we compared the results of patients undergoing UTLVR (N = 338 patients) and BTLVR (N = 344 patients) from 1993 to 1998 at five institutions. Follow-up data were available on 671 patients (98.4%) between 6 and 12 months after surgery, and a patient self-assessment was obtained at a mean of 24 months. Results. It was found that BTLVR provides superior improvement in measured postoperative percent change in FEV 1 (L) (UTLVR 23.3% ± 55.3 vs BTLVR 33% ± 41, p = 0.04), FVC(L) (10.5% ± 31.6 vs 20.3% ± 34.3, p = 0.002) and RV(L) (−13% ± −22 vs −22% ± 17.9, p = 0.015). BTLVR also provides a slight improvement over UTLVR in patient’s perception regarding improved quality of life (UTLVR 79% vs BTLVR 88%, p = 0.03) and dyspnea relief (71% vs 61%, p = 0.03). There was no difference in mean changes in P o 2 (mm Hg) (UTLV 4.5 ± 12.3 vs BTLVR 4.9 ± 13.3, p = NS), 6-minute walk (UTLVR 26% ± 66.1 vs BTLVR 31% ± 59.6, p = NS) or decreased oxygen utilization (UTLVR 78% vs BTLVR 74%, p = NS). Conclusions. These data suggest that both UTLVR and BTLVR yield significant improvement, but the results of BTLVR seem to be superior with regard to spirometry, lung volumes, and quality of life.

Lung Volume Reduction Surgery (Lvrs) For Emphysema: Initial Experience at the University Hospital Gasthuisberg

Emphysema is a disabling disease, for which there is no curative therapy available today. Lung transplantation offers a valuable option for a very selected number of patients, however, due to the enormous organ shortage, only few patients can be offered such a therapy. Recently there has been important resurgence of interest in lung volume reduction surgery and as a consequence, we have embarked in such a program since may 1997. We have now performed unilateral lung volume reduction surgery in 29 emphysema patients (25 on the right and 4 on the left side). Twenty-four patients were already discharged home. There has been no perioperative mortality. The mean hospital stay was 19.8 ±11.4 days (range, 8-47 d). Twenty patients of whom we already have follow-up data during 6 months (m) form the further basis of this report.Six weeks after the procedure the FEV1 increased from 0.82 ± 0.28 L (28 ± 8%) to 1.05 ± 0.39 L, a mean increase of 28%. There was a further increase of the FEV1 to a maximum of 1.06 ± 0.42 L at 6 m, a mean maximum increase of 29% (p=0.0046, ANOVA). Sim-ilarly, the FVC increased from 2.80±1.10Lto3.15± 1.00 L, a mean increase of 12.5%. A further increase was also obtained at 6 m and was 19.6% (3.35 ± 1.05 L, p=0.014, ANOVA). The maximum decrease in RV was obtained at 3 m (from 5.91 ± 1.37 L to 4.37 ± 0.85 L (p=0.0001, ANOVA), a mean decrease of 26%. The maximum TLC decrease was demonstrated at 3 m (from 8.71 ± 1.71 L to 7.60 ± 1.56 L (p=0.002, ANOVA), a mean decrease of 12.8%. Afterwards there was again a gradual raise of the TLC. The six minute walking distance increased from 231 ±31 m to 272 ± 34 m (p=NS) after pulmonary rehabilitation and to 416 i 77 in at 3 m and 415 ± 18 m at 6 m (p=0.0002, ANOVA) after the operation. The quality of life (measured with a standardized questionnaire, the Nottingham Health Profile ) improved significantly in several domains (e.g. mobility, pain, energy, emotions and social) at 3 m postoperatively.There was one late death (at 6 m) due to an unknown cause. The actuarial survival rate was therefore 100% at 3 m and 95% at 12 m.In conclusion, unilateral thoracoscopic lung volume reduction surgery is a new and safe treatment modality for patients suffering from severe end-stage emphysema. The objective and subjective improvement is marked and the mortality is very low. Rigid selection criteria are, however, necessary to be able to guarantee an optimal result.