Lung volume reduction surgery for pulmonary emphysema

Several million patients suffer from the shortness of breath and functional disability associated with pulmonary emphysema. A comprehensive medical treatment plan involving appropriate bronchodilator and anti-inflammatory treatment, smoking cessation and pulmonary rehabilitation are the hallmarks of patient management. In spite of these efforts, pulmonary emphysema is often characterized by a progressive clinical course resulting in further patient compromise.

During the last few years a rekindling of interest in the surgical management of pulmonary emphysema has occurred as a means of reversing the downward course of carefully selected patients suffering from this chronically progressive disease. The basic concepts of this procedure involve reducing the volume of functionally disturbed and overexpanded bullous lung tissue so that the intrinsic "springiness" to the lung can be restored. The function of the muscles of respiration (diaphragm and intercostal musculature) also is made more efficient by reducing the size of the lung, which increases their freedom to contract.

Thoracic surgeons of the Allegheny Center for Lung and Thoracic Disease have been leaders in the efforts to define the role of this procedure in the management of pulmonary emphysema and also to determine the patients most likely to benefit from the surgery. Their experience with lung volume reduction surgery for pulmonary emphysema is among the most extensive in North America.

This surgery is accomplished through a breastbone-splitting approach through which both lungs are operated on simultaneously or through bilateral "minimally invasive" thoracoscopic approaches under the same general anesthesia. In either circumstance, surgeons usually choose to operate upon both of the lungs to achieve the greatest benefit for the patient. The decision by the thoracic surgeon to utilize one or the other approach is based upon the distribution of the patient's pulmonary emphysema and his physiologic condition.

Patients with emphysema being considered for lung volume reduction surgery undergo important physiologic and radiologic testing under the direction of the center's surgeons and pulmonary physicians. A weekly conference involving thoracic surgeons, pulmonologists, radiologists and cardiopulmonary rehabilitation specialists aims at identifying the best candidates for the surgery and arranging appropriate supportive therapies before and after surgery.

Pictured: the usual sites of the small incisions used to accomplish the thoracoscopic approach to lung volume reduction surgery. Diseased lung tissue is removed to restore lung elasticity and improve the function of the diaphragm muscle.

Director
Robert J Keenan, M.D.

Co-Directors
Peter Kaplan, M.D.
Richard H Maley, Jr., M.D.

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