New and emerging minimally invasive techniques for lung volume reduction.

Lung volume reduction surgery (LVRS) has been shown to improve pulmonary function, exercise capacity, quality of life, and survival in selected patients with heterogeneous emphysema. However, LVRS is a major surgical procedure with potential morbidity and mortality. Minimally invasive techniques are emerging to achieve lung volume reduction without open thoracotomy. Devices and techniques under study include one-way bronchial valves inserted via fiberoptic bronchoscopy to promote atelectasis in emphysematous lung, promotion of focal atelectasis and fibrosis by bronchoscopic injection of polymers into emphysematous regions of lung, bronchopulmonary fenestrations to enhance expiratory flow, and thoracoscopic plication or compression of emphysematous lung. The goal of all of these procedures is to replicate the benefit of LVRS without the trauma, risks, and extended recovery of open LVRS. Refinement and application of these techniques will allow patients with emphysema and their physicians and surgeons to choose from a number of viable options for lung volume reduction.

[1]  G. Criner,et al.  Prospective Randomized Trial Comparing Bilateral Lung Volume Reduction Surgery to Pulmonary Rehabilitation in Severe Chronic Obstructive Pulmonary Disease , 1999 .

[2]  E. Ingenito,et al.  Bronchoscopic volume reduction: a safe and effective alternative to surgical therapy for emphysema. , 2001, American journal of respiratory and critical care medicine.

[3]  R. Mckenna,et al.  Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema. , 1996, The Annals of thoracic surgery.

[4]  R. Rogers,et al.  Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema. , 1996, The New England journal of medicine.

[5]  G. Snider,et al.  Reduction pneumoplasty for giant bullous emphysema. Implications for surgical treatment of nonbullous emphysema. , 1996, Chest.

[6]  P. E. Walters,et al.  Lung volume reduction surgery. Case selection, operative technique, and clinical results. , 1996, Annals of surgery.

[7]  T. Mineo,et al.  Reduction pneumoplasty versus respiratory rehabilitation in severe emphysema: a randomized study. Pulmonary Emphysema Research Group. , 2000, The Annals of thoracic surgery.

[8]  Steven Piantadosi,et al.  Patients at high risk of death after lung-volume-reduction surgery. , 2001, The New England journal of medicine.

[9]  J. Cooper,et al.  Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease. , 1995, The Journal of thoracic and cardiovascular surgery.

[10]  Steven Piantadosi,et al.  A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. , 2003, The New England journal of medicine.

[11]  John B. West,et al.  Pulmonary Pathophysiology: The Essentials , 1982 .

[12]  R. Mckenna,et al.  Bovine pericardium versus bovine collagen to buttress staples for lung reduction operations. , 1998, The Annals of thoracic surgery.

[13]  N. Zamel,et al.  Lung function 5 yr after lung volume reduction surgery for emphysema. , 2001, American journal of respiratory and critical care medicine.

[14]  G. Patterson,et al.  Bronchial fenestration improves expiratory flow in emphysematous human lungs. , 2003, The Annals of thoracic surgery.

[15]  K. Osann,et al.  Effects of a novel implantable elastomer device for lung volume reduction surgery in a rabbit model of elastase-induced emphysema. , 2002, Chest.

[16]  G. Snell,et al.  Bronchoscopic lung volume reduction (BLVR) using bronchial prostheses: a pilot safety and efficacy study , 2002 .

[17]  D. Gierada,et al.  A Prospective Evaluation of Lung Volume Reduction Surgery in 200 Consecutive Patients. , 2003, Chest.

[18]  W. Richards,et al.  No-cut thoracoscopic lung plication: a new technique for lung volume reduction surgery. , 1997, Journal of the American College of Surgeons.

[19]  D. Hansell,et al.  Effect of lung-volume-reduction surgery in patients with severe emphysema. , 2000, The New England journal of medicine.

[20]  E. Ingenito,et al.  Bronchoscopic lung volume reduction using tissue engineering principles. , 2003, American journal of respiratory and critical care medicine.

[21]  N. Gonzalez.  Pulmonary Pathophysiology: The Essentials, 5th Edition , 1999 .

[22]  K. Naunheim,et al.  Effect of bovine pericardial strips on air leak after stapled pulmonary resection. , 1997, The Annals of thoracic surgery.

[23]  J. Swain.  Surgery for Diffuse Emphysema , 1996 .

[24]  D. Hansell,et al.  Bronchoscopic volume reduction with valve implants in patients with severe emphysema. , 2003, The Lancet.

[25]  N. Nishiumi,et al.  Application of the fold plication method for unilateral lung volume reduction in pulmonary emphysema. , 1999, The Annals of thoracic surgery.