Lung volume reduction surgery by intra-bullous fibrin sealant application using thoracoscopy, an alternative in the management of vanishing lung syndrome

Abstract

Background: To investigate the efficacy of lung volume reduction surgery (LVRS) through the application of intra-bullous fibrin sealant using thoracoscopy in patients diagnosed with vanishing lung syndrome(VLS). Methods: A retrospective analysiswas conducted on the clinical data of patients with VLS who were admitted to the West China Hospital of Sichuan University between March 2022 and September 2023. Patients who met the inclusion criteria underwent LVRS and were followed up to evaluate the efficacy and safety of the technique. Results: A total of seven male patients were included, with a median age of 61 years. The patients' post-operative activity tolerance, as assessed by the chronic obstructive pulmonary disease assessment test (CAT) score and the 6-minute walk test (6-MWT), showed continuous significant improvement. Besides, five patients injected with at least 20 mL of fibrin sealant underwent successful reduction and received double-lumen endotracheal intubation while under anesthesia. The operation failed in two patients with fibrin sealant injection volume less than 12 mL. However, no significant postoperative complications were observed except for one patient with 20 mL pleural hemorrhage and a maximum of 28 days of postoperative air leakage. Conclusion: The application of intra-bullous fibrin sealant through thoracoscopy is a safe and effective approach for managing VLS, resulting in minimal wound and fewer complications. The success of this strategy depends on using dual lumen tracheal intubation to block lung ventilation and applying the appropriate amount of fibrin sealant. Retrospective trial registration: (Chinese Clinical Trial Center, registration number: ChiCTR2300078038, registered 2023-11-27)