Download PDF
Thorac Cardiovasc Surg
DOI: 10.1055/a-2572-6755
Original Thoracic

Uniportal Video-Assisted Anatomical Lung Volume Reduction Surgery in Severe Emphysema

Hayan Merhej   *
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Akylbek Saipbaev   *
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Tomoyuki Nakagiri
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Alaa Selman
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Heiko Golpon
2   Department of Pneumology and Respiratory Medicine, Hannover Medical School, Hannover, Germany
,
Tobias Goecke
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Patrick Zardo
1   Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Introduction

Lung volume reduction surgery (LVRS) is an important treatment option for patients with advanced emphysema and is typically performed in a non-anatomical fashion. This study reports the outcome of anatomical LVRS by means of uniportal video-assisted thoracoscopic surgery (VATS).

Methods

We retrospectively evaluated patients who underwent anatomical LVRS between June 2017 and September 2023 at our institution. Patient characteristics, including demographic data, lung function, as well as morbidity and mortality, were extracted from hospital records.

Results

A total of 44 patients (17 males, 38.6%) underwent anatomical LVRS at our institution during the observation period. The preoperative forced expiratory volume per second (FEV1) and FEV1% were 35.4 ± 20.0% and 45.7 ± 18.2%, respectively. Lobectomy was performed in 37 patients (84.1%), while segmentectomy was performed in 10 patients (22.7%, duplicated). Postoperative FEV1 and FEV1% significantly improved compared to preoperative values at the initial follow-up (11.8 ± 6.9 months after the operation): 38.3 ± 19.5%, p < 0.002 and 49.4 ± 18.4%, p < 0.01, respectively. Unfortunately, two patients (4.5%) died within 30 days postoperation. A further follow-up lung function test was performed in 25 patients (56.8%) at 33.1 ± 13.8 months after the operation, showing that FEV1 and FEV1% remained similar to the preoperative values (33.9 ± 20.7%, p = 0.10 and 45.3 ± 18.1%, p = 0.06, respectively).

Conclusion

Anatomical lung resection via uniportal VATS is an effective procedure for LVRS in patients with severe emphysema and is associated with acceptable morbidity and mortality.

Keywords

emphysema - bullae - thoracoscopy - VATS - pulmonary function

Data Availability Statement

Data available on request. The data underlying this article will be shared upon reasonable request to the corresponding author.


* These authors contributed equally to this paper.




Publication History

Received: 14 January 2025

Accepted: 01 April 2025

Accepted Manuscript online:
03 April 2025

Article published online:
30 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Adeloye D, Song P, Zhu Y, Campbell H, Sheikh A, Rudan I. NIHR RESPIRE Global Respiratory Health Unit. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med 2022; 10 (05) 447-458
    CrossrefPubMedSearch in Google Scholar
  • 2 Cooper JD, Lefrak SS. Lung-reduction surgery: 5 years on. Lancet 1999; 353 (Suppl. 01) SI26-SI27
    PubMedSearch in Google Scholar
  • 3 Naunheim KS, Wood DE, Mohsenifar Z. et al.; National Emphysema Treatment Trial Research Group. Long-term follow-up of patients receiving lung-volume-reduction surgery versus medical therapy for severe emphysema by the National Emphysema Treatment Trial Research Group. Ann Thorac Surg 2006; 82 (02) 431-443
    CrossrefPubMedSearch in Google Scholar
  • 4 Criner GJ, Cordova F, Sternberg AL, Martinez FJ. The National Emphysema Treatment Trial (NETT) Part II: Lessons learned about lung volume reduction surgery. Am J Respir Crit Care Med 2011; 184 (08) 881-893
    CrossrefPubMedSearch in Google Scholar
  • 5 Clark SJ, Zoumot Z, Bamsey O. et al. Surgical approaches for lung volume reduction in emphysema. Clin Med (Lond) 2014; 14 (02) 122-127
    PubMedSearch in Google Scholar
  • 6 Cornelius T. Clinical guideline highlights for the hospitalist: GOLD COPD update 2024. J Hosp Med 2024; 19 (09) 818-820
    PubMedSearch in Google Scholar
  • 7 Le Pimpec-Barthes F, Das Neves-Pereira JC, Cazes A. et al. [Lung volume reduction surgery for emphysema and bullous pulmonary emphysema]. Rev Pneumol Clin 2012; 68 (02) 131-145
    PubMedSearch in Google Scholar
  • 8 Brantigan OC, Mueller E, Kress MB. A surgical approach to pulmonary emphysema. Am Rev Respir Dis 1959; 80 (1, Part 2): 194-206
    CrossrefPubMedSearch in Google Scholar
  • 9 Vaughan P, Oey I, Nakas A, Martin-Ucar A, Edwards J, Waller D. Is there a role for therapeutic lobectomy for emphysema?. Eur J Cardiothorac Surg 2007; 31 (03) 486-490 , discussion 490
    PubMedSearch in Google Scholar
  • 10 Cooper JD, Patterson GA, Sundaresan RS. et al. Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema. J Thorac Cardiovasc Surg 1996; 112 (05) 1319-1329 , discussion 1329–1330
    CrossrefPubMedSearch in Google Scholar
  • 11 Wisser W, Tschernko E, Senbaklavaci O. et al. Functional improvement after volume reduction: sternotomy versus videoendoscopic approach. Ann Thorac Surg 1997; 63 (03) 822-827 , discussion 827–828
    PubMedSearch in Google Scholar
  • 12 Eichhorn ME, Gompelmann D, Hoffmann H. et al. Consolidating lung volume reduction surgery after endoscopic lung volume reduction failure. Ann Thorac Surg 2021; 111 (06) 1858-1865
    CrossrefPubMedSearch in Google Scholar
  • 13 Beckers F, Lange N, Koryllos A, Picchioni F, Windisch W, Stoelben E. Unilateral lobe resection by video-assisted thoracoscopy leads to the most optimal functional improvement in severe emphysema. Thorac Cardiovasc Surg 2016; 64 (04) 336-342
    PubMedSearch in Google Scholar
  • 14 Herth FJ, Eberhardt R, Gompelmann D. et al. Radiological and clinical outcomes of using Chartis™ to plan endobronchial valve treatment. Eur Respir J 2013; 41 (02) 302-308
    CrossrefPubMedSearch in Google Scholar
  • 15 American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 152 (5 Pt 2): S77-S121
    PubMedSearch in Google Scholar
  • 16 Agarwal AK, Raja A, Brown BD. Chronic Obstructive Pulmonary Disease. Treasure Island (FL): StatPearls Publishing LLC; 2025
    Search in Google Scholar
  • 17 Anthonisen NR, Connett JE, Kiley JP. et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 1994; 272 (19) 1497-1505
    CrossrefPubMedSearch in Google Scholar
  • 18 Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 1997; 155 (04) 1283-1289
    PubMedSearch in Google Scholar
  • 19 Hoppin Jr FG. Theoretical basis for improvement following reduction pneumoplasty in emphysema. Am J Respir Crit Care Med 1997; 155 (02) 520-525
    PubMedSearch in Google Scholar
  • 20 Voskrebenzev A., Klimeš F., Wacker F., Vogel-Claussen J.. Phase-Resolved Functional Lung MRI for Pulmonary Ventilation and Perfusion (V/Q) Assessment. J Vis Exp 2024; 210: e66380
    PubMedSearch in Google Scholar
  • 21 Kaireit TF, Voskrebenzev A, Gutberlet M. et al. Comparison of quantitative regional perfusion-weighted phase resolved functional lung (PREFUL) MRI with dynamic gadolinium-enhanced regional pulmonary perfusion MRI in COPD patients. J Magn Reson Imaging 2019; 49 (04) 1122-1132
    CrossrefPubMedSearch in Google Scholar