Quasilobar minimalist lung volume reduction surgery

2021 ◽  
Author(s):  
Eugenio Pompeo ◽  
Ahmed Elkhouly ◽  
Paola Rogliani ◽  
Mario Dauri ◽  
Michael Peer ◽  
...  
Keyword(s):  
Lung Volume ◽  
Study Groups ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Perioperative Outcomes ◽  
Morbidity Rate ◽  
Residual Volume ◽  
Control Groups ◽  
Lung Volume Reduction ◽  
Thoracic Epidural

Abstract OBJECTIVES Our goal was to assess the results and the costs of the quasilobar minimalist (QLM) thoracoscopic lung volume reduction (LVR) surgical method developed to minimize the trauma from the operation and the anaesthesia and to maximize the effect of the lobar volume reduction. METHODS Forty patients with severe emphysema underwent QLM-LVR that entailed adoption of sole intercostal block analgesia and lobar plication through a single thoracoscopic incision. Results were compared after propensity matching with 2 control groups undergoing non-awake resectional LVR with double-lumen tracheal intubation or awake non-resectional LVR by plication with thoracic epidural anaesthesia. As a result, we had 3 matched groups of 30 patients each. RESULTS Baseline forced expiratory volume in 1 s, residual volume, the 6-min walking test and the modified Medical Research Council dyspnoea index were 0.77 ± 0.18, 4.97 ± 0.6, 328 ± 65 and 3.3 ± 0.7, respectively, with no intergroup difference after propensity score matching. The visual pain score was better (P < 0.007), the hospital stay was shorter (P < 0.04) and overall costs were lower (P < 0.04) in the QLM-LVR group than in the control groups. The morbidity rate was lower with QLM-LVR than with non-awake resectional-LVR (P = 0.006). Significant improvements (P < 0.001) occurred in all study groups during the follow-up period. At 24 months, improvements in residual volume and dyspnoea index were significantly better with QLM-LVR (P < 0.04). CONCLUSIONS QLM-LVR proved safe and showed better perioperative outcomes and lower procedure-related costs than the control groups. Similar clinical benefit occurred at 12 months, but absolute improvements in residual volume and dyspnoea index were better in the QLM-LVR group at 24 months.

scholarly journals Change in Dynamic Hyperinflation After Bronchoscopic Lung Volume Reduction in Patients with Emphysema

Lung ◽  
2020 ◽  
Vol 198 (5) ◽  
pp. 795-801
Author(s):  
Marlies van Dijk ◽  
Karin Klooster ◽  
Jorine E. Hartman ◽  
Nick H. T. ten Hacken ◽  
Dirk-Jan Slebos
Keyword(s):  
Treatment Group ◽  
Lung Volume ◽  
Standard Of Care ◽  
Volume Reduction ◽  
Control Group ◽  
Dynamic Hyperinflation ◽  
Residual Volume ◽  
Lung Volume Reduction ◽  
Severe Emphysema ◽  
Before And After

Abstract Background and Purpose In patients with severe emphysema, dynamic hyperinflation is superimposed on top of already existing static hyperinflation. Static hyperinflation reduces significantly after bronchoscopic lung volume reduction (BLVR). In this study, we investigated the effect of BLVR compared to standard of care (SoC) on dynamic hyperinflation. Methods Dynamic hyperinflation was induced by a manually paced tachypnea test (MPT) and was defined by change in inspiratory capacity (IC) measured before and after MPT. Static and dynamic hyperinflation measurements were performed both at baseline and 6 months after BLVR with endobronchial valves or coils (treatment group) or SoC (control group). Results Eighteen patients underwent BLVR (78% female, 57 (43–67) years, FEV1 25(18–37) %predicted, residual volume 231 (182–376) %predicted). Thirteen patients received SoC (100% female, 59 (44–74) years, FEV1 25 (19–37) %predicted, residual volume 225 (152–279) %predicted. The 6 months median change in dynamic hyperinflation in the treatment group was: + 225 ml (range − 113 to + 803) (p < 0.01) vs 0 ml (− 1067 to + 500) in the control group (p = 0.422). An increase in dynamic hyperinflation was significantly associated with a decrease in residual volume (r = − 0.439, p < 0.01). Conclusion Bronchoscopic lung volume reduction increases the ability for dynamic hyperinflation in patients with severe emphysema. We propose this is a consequence of improved static hyperinflation.

Physiological characterization of variability in response to lung volume reduction surgery

2003 ◽  
Vol 94 (1) ◽  
pp. 20-30 ◽  
Author(s):  
Edward P. Ingenito ◽  
Stephen H. Loring ◽  
Marilyn L. Moy ◽  
Steven J. Mentzer ◽  
Scott J. Swanson ◽  
...  
Keyword(s):  
Lung Volume ◽  
Airway Resistance ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Mechanics ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Recoil Pressure ◽  
Physiological Characterization

This paper examines potential physiological mechanisms responsible for improvement after lung volume reduction surgery (LVRS). In 25 patients (63 ± 9 yr; 11 men, 14 women), spirometry [forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)], lung volumes [residual volume (RV) and total lung capacity (TLC)], small airway resistance, recoil pressures, and respiratory muscle contractility (RMC) were measured before and 4–6 mo after LVRS. Data were interpreted to assess how changes in each component of lung mechanics affect overall function. Among responders (ΔFEV1 ≥ 12%; 150 ml), improvement was primarily due to an increase in FVC, not to FEV1-to-FVC ratio. Among nonresponders, FEV1, FVC, and RV/TLC did not change after surgery, although recoil pressure increased in both groups. Both groups experienced a reduction in RMC after LVRS. In conclusion, LVRS improves function in emphysema by resizing the lung relative to the chest wall by reducing RV. LVRS does not change airway resistance but decreases RMC, which attenuates the potential benefits of LVRS that are generated by reducing RV/TLC. Among nonresponders, recoil pressure increased out of proportion to reduced volume, such that no increase in vital capacity or improvement in FEV1 occurred.

scholarly journals Individualised risk in patients undergoing lung volume reduction surgery: the Glenfield BFG score

2017 ◽  
Vol 49 (6) ◽  
pp. 1601766 ◽  
Author(s):  
Neil J. Greening ◽  
Paul Vaughan ◽  
Inger Oey ◽  
Michael C. Steiner ◽  
Mike D. Morgan ◽  
...  
Keyword(s):  
Risk Score ◽  
Lung Volume ◽  
Characteristic Curve ◽  
Risk Groups ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Chronic Obstructive ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Obstructive Pulmonary Disease

Lung volume reduction surgery (LVRS) has been shown to be beneficial in patients with chronic obstructive pulmonary disease, but there is low uptake, partly due to perceived concerns of high operative mortality. We aimed to develop an individualised risk score following LVRS.This was a cohort study of patients undergoing LVRS. Factors independently predicting 90-day mortality and a risk prediction score were identified. Reliability of the score was tested using area under the receiver operating characteristic curve (AUROC).237 LVRS procedures were performed. The multivariate analysis factors associated independently with death were: body mass index (BMI)<18.5 kg·m−2 (OR 2.83, p=0.059), forced expiratory volume in 1 s (FEV1)<0.71 L (OR 5.47, p=0.011) and transfer factor of the lung for carbon monoxide (TLCO) <20% (OR 5.56, p=0.031). A risk score was calculated and total score assigned. AUROC for the risk score was 0.80 and a better predictor than individual components (p<0.01). The score was stratified into three risk groups. Of the total patients, 46% were classified as low risk. Similar improvements in lung function and health status were seen in all groups. The score was introduced and tested in a further 71 patients. AUROC for 90-day mortality in this cohort was 0.84.It is possible to provide an individualised predictive risk score for LVRS, which may aid decision making for both clinicians and patients.

scholarly journals Implementation of Bronchoscopic Lung Volume Reduction Using One-Way Endobronchial Valves: A Retrospective Single-Centre Cohort Study

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Rein Posthuma ◽  
Anouk W. Vaes ◽  
Kim H. M. Walraven ◽  
Peyman Sardari Nia ◽  
Jan U. Schreiber ◽  
...  
Keyword(s):  
Lung Volume ◽  
Real Life ◽  
High Volume ◽  
Forced Expiratory Volume ◽  
Outcome Data ◽  
Volume Reduction ◽  
Small Subset ◽  
Lung Volume Reduction ◽  
Invasive Treatment

<b><i>Background:</i></b> Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program. <b><i>Objectives:</i></b> In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes. <b><i>Method:</i></b> A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV<sub>1</sub>), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample <i>t</i> tests were performed to compare means before and after intervention. <b><i>Results:</i></b> Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax (<i>n</i> = 2) or lack of benefit (<i>n</i> = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change ± SD in CAT −4 ± 6 points, FEV<sub>1</sub> +190 ± 140 mL, RV −770 ± 790 mL, and +37 ± 65 m on the 6MWT (all <i>p</i> &#x3c; 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. <b><i>Conclusion:</i></b> Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.

scholarly journals Endoscopic lung volume reduction with endobronchial valves in very low DLCO patients: results from the German Registry (Lungenemphysemregister e.V.)

2020 ◽  
pp. 00449-2020
Author(s):  
Pavlina Lenga ◽  
Christoph Ruwwe-Glösenkamp ◽  
Christian Grah ◽  
Joachim Pfannschmidt ◽  
Jens Rückert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Exercise Capacity ◽  
Lung Volume ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction ◽  
Lung Emphysema

BackgroundEndoscopic lung volume reduction (ELVR) with valves has been suggested to be the key strategy for patients with severe emphysema and concomitant low diffusion capacity of the lung for carbon monoxide (DLCO). However, robust evidence is still missing. We therefore aim to compare clinical outcomes in relation to DLCO for patients treated with ELVR.MethodsWe assessed DLCO at baseline and 3-months follow-up and compared pre- and postprocedural pulmonary function test (PFT), quality of life, exercise capacity and adverse events. This is a retrospective subanalysis of prospectively collected data from the German Lung Emphysema Registry.Results121 patients treated with ELVR were analysed. 34 patients with a DLCO ≤20% and 87 patients with a DLCO >20% showed similar baseline characteristics. After ELVR, there was a decrease of residual volume (both p<0.001 to baseline) in both groups and both demonstrated better quality of life (p<0.01 to baseline). Forced expiratory volume in 1 s (FEV1) improved significantly only in patients with a DLCO >20% (p<0.001 to baseline). Exercise capacity remained almost unchanged in both groups (p=0.3). The most frequent complication for both groups was a pneumothorax (DLCO ≤20%: 17.6% versus DLCO >20%: 16.1%; p=0.728). However, there were no significant differences in other adverse events between both groups.ConclusionsELVR improves lung function as well as quality of life in patients with DLCO >20% and DLCO ≤20%. Adverse events did not differ between groups. Therefore, ELVR should be considered as a treatment option, even in patients with a very low DLCO.

Nursing care of the thoracoscopic lung volume reduction patient

1996 ◽  
Vol 5 (6) ◽  
pp. 412-419
Author(s):  
KJ Vaca ◽  
JF Osterloh ◽  
CJ Daake ◽  
NR Noedel
Keyword(s):  
Quality Of Life ◽  
Pulmonary Function ◽  
Nursing Care ◽  
Lung Volume ◽  
Forced Expiratory Volume ◽  
Minute Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction ◽  
Prolonged Air Leak

BACKGROUND: Several methods to surgically enhance pulmonary function and improve the quality of life in patients with bullous emphysema are currently being evaluated. One of these methods, lung volume reduction, is performed in patients with bullous emphysema that can no longer be well managed with medical therapy. OBJECTIVES: The focus of this article is to review bullectomy via unilateral thoracoscopy with an endoscopic stapler in the management of end-stage pulmonary emphysema, and to discuss nursing care of these patients. METHODS: An experimental study was used, including review of the literature and analysis of clinical experience using chi-square and t test analyses of pre- and postoperative variables. RESULTS: At 3-month follow-up there were significant improvements in forced expiratory volume in 1 second, forced vital capacity, minute volume ventilation, partial pressure of oxygen, residual volume, and 6-minute walk when pre- and postoperative parameters were compared. Operative mortality was 4%, with the most common complication being prolonged air leak, occurring in 30% of patients studied. CONCLUSIONS: There is now consistent preliminary information to support the concept that lung volume reduction improves pulmonary function and quality of life in a significant percentage of patients.

Predictors of Improvement in FEV 1 (Forced Expiratory Volume in 1 s) After Lung Volume Reduction Surgery

Surgery Today ◽  
2000 ◽  
Vol 30 (4) ◽  
pp. 328-332 ◽  
Author(s):  
Hiroshi Date ◽  
Keiji Goto ◽  
Ryo Souda ◽  
Shigehito Endou ◽  
Motoi Aoe ◽  
...  
Keyword(s):  
Lung Volume ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction

scholarly journals Identification of target zones for lung volume reduction surgery using three-dimensional computed tomography rendering

2020 ◽  
Vol 6 (3) ◽  
pp. 00305-2020
Author(s):  
Claudio Caviezel ◽  
Tamara Froehlich ◽  
Didier Schneiter ◽  
Urs Muehlematter ◽  
Thomas Frauenfelder ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Volume ◽  
New Technology ◽  
Pulmonary Function Tests ◽  
Three Dimensional ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction Surgery ◽  
Target Zones ◽  
Lung Volume Reduction

BackgroundThe key issues for performing lung volume reduction surgery (LVRS) is the identification of the target zones. Recently introduced three-dimensional computed tomography rendering methods are used to identify the morphological distribution and its severity of lung emphysema by densitometry. We demonstrate a new software for emphysema imaging and show the pre- and post-operative results in patients undergoing LVRS planned based on this new technology.MethodsA real-time three-dimensional image analysis software system was used pre- and 3 months post-operatively in five patients with heterogeneous emphysema and a single patient with homogeneous morphology scheduled for LVRS. Focus was on low attenuation areas with <950 HU, distribution on both lungs and the value of the three-dimensional images for planning surgery. Functional outcome was assessed by pulmonary function tests after 3 months.ResultsFive patients underwent bilateral LVRS and one patient had unilateral LVRS. All patients showed a median increase in forced expiratory volume in 1 s of 70% (range 30–120%), compared with baseline values. Hyperinflation (expressed as residual volume/total lung capacity ratio) was reduced by 30% (range 5–32%). In the patients with heterogeneous emphysema, the pre- and post-operative computed tomography scans and the densitometries showed a decrease in low attenuation areas by 23% (right side) and by 17% (left side), respectively.ConclusionWe demonstrate three-dimensional computed tomography-rendered images for planning personalised remodelling of hyperinflated lungs using LVRS. This user-friendly software has the potential to assist surgeons and interventional pulmonologists to select patients and to visualise target areas in LVRS procedures.

scholarly journals Lung volume reduction surgery as salvage procedure after previous use of endobronchial valves

2020 ◽  
Author(s):  
Claudio Caviezel ◽  
Laura-Chiara Guglielmetti ◽  
Mateja Ladan ◽  
Henrik Jessen Hansen ◽  
Michael Perch ◽  
...  
Keyword(s):  
Lung Volume ◽  
Forced Expiratory Volume ◽  
Current Data ◽  
Volume Reduction ◽  
Salvage Procedure ◽  
Fistula Closure ◽  
Air Leak ◽  
Lung Volume Reduction ◽  
Secondary Failure ◽  
Significant Clinical Improvement

Abstract OBJECTIVES Lung volume reduction (LVR) is an efficient and approved treatment for selected emphysema patients. There is some evidence that repeated LVR surgery (LVRS) might be beneficial, but there are no current data on LVRS after unsuccessful bronchoscopic LVR (BLVR) with endobronchial valves (EBVs). We hypothesize good outcome of LVRS after BLVR with valves. METHODS In this study, we retrospectively investigated all patients who underwent LVRS between 2015 and 2019 at 2 centres after previous unsuccessful EBV treatment. They were further divided into subgroups with patients who never achieved the intended improvement after BLVR (primary failure) and patients whose benefit was fading over time due to the natural development of emphysema (secondary failure). Patients with severe air leak after BLVR and immediate concomitant LVRS and fistula closure thereafter were analysed separately. RESULTS A total of 38 patients were included. Of these, 19 patients had primary failure, 15 secondary failure and 4 were treated as an emergency due to severe air leak. At 3 months after LVRS, forced expiratory volume in 1 s had improved significantly by 12.5% (P = 0.011) and there was no 90-day mortality. Considering subgroups, patients with primary failure after BLVR seem to profit more than those with secondary failure. Patients with severe air leak after BLVR did not profit from fistula closure with concomitant LVRS. CONCLUSIONS LVRS after previous BLVR with EBVs can provide significant clinical improvement with low morbidity, although results might not be as good as after primary LVRS.

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