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No-cut thoracoscopic lung plication: a new technique for lung volume reduction surgery
S J Swanson1, S J Mentzer, M M DeCamp
1Division of Thoracic Surgery and Pulmonary/Critical Care Division, Brigham and Women's Hospital, the Harvard Medical School, Boston, MA 02115, USA.
Journal of the American College of Surgeons
|July 1, 1997
Summary
This study introduces a novel, minimally invasive lung plication technique for emphysema, preserving the visceral pleura. This approach shows promise for effective lung volume reduction with reduced complications.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Minimally Invasive Procedures
Background:
- Lung volume reduction surgery (LVRS) is a therapy for symptomatic emphysema.
- Current methods like linear cutting staplers or laser ablation carry risks of morbidity and mortality, primarily due to air leaks from visceral pleural division.
- A novel technique using minimally invasive methods to achieve lung volume reduction while preserving the visceral pleura is presented.
Purpose of the Study:
- To report a novel technique for lung volume reduction surgery (LVRS) that preserves the visceral pleura.
- To evaluate the feasibility and outcomes of this minimally invasive lung plication method.
Main Methods:
- A prospective analysis of 32 patients undergoing thoracoscopic lung plication between May 1995 and September 1996.
- Utilized a novel lung grasper and a knifeless stapler for permanent lung tissue plication without cutting the visceral pleura.
- Standard indications for LVRS were followed, including severe dyspnea, hyperinflation, and diffuse emphysema.
Main Results:
- No perioperative deaths occurred in 32 patients (50 procedures).
- Postoperative morbidity was 39%, with 4% requiring thoracotomy for air leaks.
- Significant improvement in pulmonary function was observed, with a mean increase in forced expiratory volume in one second (FEV1) of 29% for the entire group.
Conclusions:
- Minimally invasive lung plication techniques can achieve significant lung volume reduction.
- This no-cut lung plication method demonstrates favorable postoperative morbidity and mortality.
- Lung plication shows promise as an alternative technique for LVRS.