Respiratory Medicine: e-learning
Lung Volume Reduction Surgery
Please read the following journal article:
- Fishman A, Martinez F, Naunheim K, Piantadosi S, Wise R, Ries A, Weinmann G, Wood DE; National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003 May 22;348(21):2059-73.
And complete a short set of MCQs
Local approach to lung volume reduction surgery in Hull
Lung volume reduction surgery (LVRS) aims to remove the least functional part of the lungs in order to improve airflow, diaphragm and chest wall mechanics and alveolar gas exchange in the remaining portion of the lung.
As there is a very good support from the cardiothoracic team in Hull, a routine identification of patients with emphysema occurs for assessment for lung volume reduction surgery. The ideal patients are those with low exercise capacity and predominately upper lobe emphysema. Patients with high mortality including those with FEV1≤20% of predicted, homogenous emphysema, carbon monoxide diffusing capacity ≤20% of predicted are usually precluded from lung volume reduction surgery as the mortality risk is deemed to be too high. Lung volume reduction surgery may be an option for patients who experience breathlessness, and have pulmonary function tests that show severe obstruction and enlarged lungs. The patients must demonstrate smoking abstinence for at least 6 months (if needed random urine cotinine, a metabolite created when the body processes nicotine, tests are performed). Prior to assessment for lung volume reduction surgery, the patients should complete pulmonary rehabilitation programme and have their therapy maximised. Computed tomography of the thorax is performed to assess the distribution of emphysema. In addition radionuclide ventilation perfusion tests are performed to assess the distribution of the emphysema and to identify the diseased lung. Surgery aims to reduce the volume of each lung by between 20 and 30%. This is done by using a surgical stapling device to cut and seal the tissue, laser ablation to shrink lung volume or a combination of both. Once the tissue has been removed the lung is re-inflated and the chest closed. The diseased part of the lung can be accessed by various techniques including median sternotomy, video assisted thoracoscopy (VATS) for unilateral or bilateral surgery, or thoracotomy (unilateral surgery). Median sternotomy involves cutting through the sternum to open the chest. The video assisted procedure involves making a number of small incisions in both sides of the chest to allow the insertion of instruments into the chest between the ribs.
Further Reading:
Washko GR, Fan VS, Ramsey SD, Mohsenifar Z, Martinez F, Make BJ, Sciurba FC, Criner GJ, Minai O, Decamp MM, Reilly JJ; for the National Emphysema Treatment Trial Research Group. The effect of lung volume reduction surgery on chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med. 2008 Jan 15;177(2):164-9.