Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in industrialized nations and COPD from advanced pulmonary emphysema is a major cause of morbidity and mortality. Up to this time, the final option for selected patients with disabling respiratory failure due to COPD has been lung transplantation. However, recently, lung volume reduction surgery (LVRS) has become a new therapeutic option for patients who are either too old for lung transplantation or as a bridging procedure with the intention of deferring transplantation for younger persons. The concept of this surgical procedure was first conceived by Brantigan and Mueller (1) almost 40 years ago. They reported significant clinical improvement in 75% of patients who had this procedure and this improvement persisted in some patients for more than 5 years. Because of the high early mortality rate of 16%, and few objective data to substantiate the claims of subjective improvement, their procedure never gained widespread acceptance until revisited by Wakabayashi et al in 1991 (2), who utilized laser treatment of diffuse small bulla by a unilateral or bilateral thoracoscopic technique and demonstrated a modest improvement in pulmonary function. Thereafter, in 1995 Cooper et al returned to Brantigan's original notion of surgical resection of severely diseased but nonbullous areas of lung and modified the technique by employing median sternotomy incisions that permitted bilateral resections using a staple (3). The results showed variable clinical relief of dyspnoea and improvement in lung function. In Japan, the first few patients with severe emphysema were treated by C02 laser therapy in 1991 (4). Thereafter, many surgical centres worldwide started LVRS programs. At present, there have been more than 550 reported cases of LVRS for emphysema. The purpose of this chapter is to review LVRS for pulmonary emphysema, including our own experience.
|Title of host publication||Respiratory medicine|
|Subtitle of host publication||An asian perspective|
|Publisher||Hong Kong University Press, HKU|
|Number of pages||20|
|Publication status||Published - 2005|
ASJC Scopus subject areas
- Social Sciences(all)