Bilateral volume reduction surgery for diffuse pulmonary emphysema by video-assisted thoracoscopy

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Cardiopulmonary Rehabilitation

Background:

• Severe diffuse pulmonary emphysema significantly impairs daily activities due to airflow obstruction and hyperinflation.
• Current treatment options for advanced emphysema have limitations in improving functional capacity and quality of life.

Purpose of the Study:

• To evaluate the surgical aspects, functional outcomes, and complications of video-assisted bilateral thoracoscopic volume reduction surgery (VATS-VRS).
• To assess the impact of VATS-VRS on pulmonary function, dyspnea, and exercise performance in patients with severe emphysema.

Main Methods:

• Prospective study of 20 patients (15 men, 5 women; mean age 64 years) with severe emphysema undergoing VATS-VRS.
• Preoperative and 3-month postoperative assessments included pulmonary function tests, dyspnea grading, and exercise performance tests.
• Pulmonary function tests were also conducted before hospital discharge.

Main Results:

• No perioperative mortality; median hospital stay was 15 days.
• Significant improvements observed at 3 months: Forced Expiratory Volume in 1 second (FEV1) increased by 42% (p < 0.001), residual volume decreased (p < 0.001).
• 12-minute walking distance increased by 39% (p < 0.001), maximal oxygen consumption improved (p < 0.0005), and dyspnea (Medical Research Council score) significantly decreased.

Conclusions:

• Video-assisted bilateral thoracoscopic volume reduction surgery is a safe and effective treatment for severe diffuse pulmonary emphysema.
• The procedure leads to significant improvements in lung function, exercise capacity, and a substantial reduction in dyspnea.
• VATS-VRS offers a valuable therapeutic option for patients with end-stage emphysema, improving their overall quality of life.