The Thoracic Research Scholarship 1996 of the German Society for Thoracic and Cardiovascular
Surgery enabled me to visit Barnes Hospital at the Washington University of St. Louis,
USA, from May to July 1996. At that center Prof. J. D. Cooper has established lung-volume reduction surgery as a successful surgical treatment
for patients with endstage pulmonary emphysema. The operation is performed using left-sided
double-lumen intubation. After opening of the chest and pleura and starting single-lung
ventilation the less diseased parts of the second lung collapse due to absorption
atelectasis whereas the more diseased portion of the lung stays hyperinflated. Linear
staplers buttressed with bovine pericardium are used to resect the diseased parts
of the lungs. Approximately 20 - 30 % of the total lung volume can be resected by
this way on each side. After inspection of the lungs for air leaks and preparation
of pleural tents the pleura is closed bilaterally. Postoperative analgesia is performed
via epidural catheter and patients are extubated postoperatively as soon as possible,
usually in the operating theatre. 150 bilateral lung-volume reduction procedures for
patients with severe emphysema were performed between January 1993 and February 1996
in St. Louis. 6 months postoperatively the 1-second forced expiratory volume had increased
by up to 51 % and residual volume was reduced by 28%. 70% of patients who required
continuous oxygen supply prior to the operation no longer required this measure: the
PaO2 had increased by an average of 8 mmHg. These data demonstrate that bilateral lung-volume
reduction surgery is a suitable treatment for patientswith terminal pulmonary emphysema.
Most important for the success of this procedure are clear selection and specific
perioperative treatment of the patients.
Emphysema - Chronic obstructive lung disease - Lung-volume reduction
