Surgical Techniques: Lung Transplant and Lung Volume Reduction

Abstract

Patients with end-stage emphysema can be offered lung volume reduction surgery (LVRS), lung transplantation, or unilateral lung transplantation combined with contralateral LVRS if necessary, depending on multiple factors including age, lung function parameters, lobar predominance, and whether the disease is uni- or bilateral. Lung transplant is a complex and well-established therapeutic modality for patients with end-stage lung disease. The ideal candidate for LVRS is a patient with severe upper-lobe predominant emphysema and markedly impaired exercise capacity. Other groups may benefit from the procedure, but results are likely to be less good. The objective of this chapter is to describe the surgical techniques of bilateral lung transplantation and lung volume reduction surgery as performed at the University of Toronto.

Overview of Clinical Lung Transplantation

“…Other than blood group and organ size matching, the majority of the evaluation is relatively subjective and occurs at the time of retrieval (Boasquevisque et al 2009). Before opening the chest, a chest X-ray is taken and a bronchoscopy performed to exclude gross infection or anatomical abnormalities.…”

Successful lung volume reduction surgery after coronary artery bypass grafting: a case report

“…[1,2] Lung volume reduction surgery is effective in selected cases for palliation of symptoms. This treatment option can also improve survival and respiratory muscle inefficiency.…”

“…[1,2] This procedure has been recently re-launched by Cooper [3] who have discovered as a new method of treatment of end-stage emphysema. The most common cause of lung emphysema is chronic obstructive pulmonary disease (COPD), which is primarily caused by vapors.…”

Lung volume reduction surgery: an overview

“…A recent meta-analysis published by Berger 29 and colleagues showed similar 6 and 12 months mortality between LVRS and medical groups, after random assignment to treatment. It is well known that patients with predominantly upper-lobe have lower mortality and greater chance of improvement in exercise capacity than patients with non-upper lobe emphysema 30,31 .…”

“…resection for stage I lung cancer; 2. to wean ventilator dependent COPD patients; 3. to reduce unilateral hyperinflation of the native lung after single lung transplantation; 4. to serve not only as a bridge procedure but as an alternative for patients awaiting lung transplantation 31 .…”