Innovative Approaches to Lung Volume Reduction for Emphysema

Abstract

The 10 years of resurgent interest in lung volume reduction surgery (LVRS) and recent National Emphysema Treatment Trial findings for emphysema have stimulated a range of innovative alternative ideas aimed at improving outcomes and reducing complications associated with current LVRS techniques. Concepts being actively investigated at this time include surgical resection with compression/banding devices, endobronchial blockers, sealants, obstructing devices and valves, and bronchial bypass methods. These novel approaches are reaching the stage of clinical trials at this time. Theory, design issues, methods, potential advantages and limitations, and available results are presented. Extensive research in the near future will help to determine the potential clinical applicability of these new approaches to the treatment of emphysema symptoms.

Emphysema lung lobe volume reduction: effects on the ipsilateral and contralateral lobes

“…Previous modelbased analyses by Fessler et al for LVRS suggest that RV/ TLC may be another significant predictive variable of spirometric improvement after surgery [13]. Other predictive variables may include the presence and degree of collateral ventilation, and number and location of valves placed [14,15,36]. Future work could also involve radiographic measurement of diaphragmatic curvature, which has been used to assess hyperinflation and found to correlate with the high cost of breathing in patients with COPD [32].…”

Closure of persisting air leaks in patients with severe pleural empyema — use of endoscopic one-way endobronchial valve☆

“…These valves are unidirectional airway-blocking devices, which were originally developed for bronchoscopic lung-volume reduction in emphysema [7,8]. Air leakage ceased the moment the valve was inserted.…”

Our initial experiences with endobronchial valve: a new approach for lung volume reduction

“…Üst lob baskın amfizemi ve bazal egzersiz kapasitesi düşük olan fakat AHKC için belirlenen yüksek risk kriterlerini taşıyan hastalarda 90 günlük ameliyat sonrası mortalite oranı %29 olarak saptanmıştır. [1][2][3] Bronkoskopi, medikal tedavinin yetersiz kaldığı durumlarda ve AHKC uygulanamayacak seçilmiş hastalarda veya hastaya AHKC ya da nakil yapılana kadar zaman kazanmak için uygulanabilen minimal invaziv bir tekniktir.…”

“…Akciğer hacim küçültücü cerrahinin (AHKC) ağır amfizemi olan hastalarda egzersiz kapasitesini artırdığı ve semptomları azalttı-ğı gösterilmiştir. [1,2] Morbidite ve mortalitenin yüksek olmasından dolayı bir grup hastada AHKC yapılamaz. [3] Bu tür hastaların akciğer hacim küçültücü tedaviden yararlanabilmeleri için minimal invaziv ve daha ucuz yöntemlerin bulunması adına birçok çalışma yapılmak-tadır.…”