Skip to main content
SpringerLink
Log in

Correlation of unilateral thoracoscopic lung volume reduction with improvement in lung function and exercise performance in patients with severe pulmonary emphysema

  • Original Articles
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

This study was conducted to investigate the correlation of thoracoscopic lung volume reduction to changes in pulmonary function and exercise performance in patients with pulmonary emphysema. Unilateral thoracoscopic lung volume reduction treatment was performed in 30 patients with severe pulmonary emphysema. If large bullae were present, they were excised using an endoscopic stapling device, and the emphysematous pleura was contracted by neodymium:yttrium-aluminium-garnet laser to reduce the volume of nonfunctional lung air space. Pulmonary function and incremental exercise tests were performed before and at least 3 months after treatment. Follow-up functional evaluation showed a highly significant improvement in the forced expiratory volume in 1s (FEV1), forced vital capacity, static compliance, and maximal oxygen uptake. The functional residual capacity as measured by the gas dilution method (FRCgas), was unchanged; however, it was found to be decreased significantly when measured by body plethysmograph (FRCbox). Positive correlations existed between the reduction in FRCbox and the increase in FEV1 (r=0.586,P=0.0042) and maximal oxygen uptake (r=0.550,P=0.018). Pulmonary ventilation and exercise ability in patients with pulmonary emphysema were improved in a volume-dependent manner by thoracoscopic lung volume reduction. These findings indicate that patients with a preoperative trapped gas volume level exceeding 11 would be ideal candidates for thoracoscopic lung volume reduction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Thoracic Society (1962) Chronic bronchitis, asthma and pulmonary emphysema: a statement by the Committee on Diagnostic Standards for Nontuberculous Respiratory Disease. Am Rev Resp Dis 85:762–768

    Google Scholar 

  2. Connolly JE, Wilson A (1989) The current status of surgery for bullous emphysema. J Thrac Cardiovasc Surg 97:351–361

    CAS  Google Scholar 

  3. Brantigan OC, Mueller E (1957) Surgical treatment of pulmonary emphysema. Am Surg 23:789–804

    CAS  PubMed  Google Scholar 

  4. Brantigan OC, Mueller E, Kress MB (1959) A surgical approach to pulmonary emphysema. Am Rev Respir Dis 80:194–202

    CAS  PubMed  Google Scholar 

  5. Wakabayashi A, Brenner M, Kayaleh RA, Berns MW, Barker SJ, Rice SJ, Tadir Y, Bella LD, Wilson AF (1991) Thoracoscopic carbon dioxide laser treatment of bullous emphysema. Lancet 337:881–883

    Article  CAS  PubMed  Google Scholar 

  6. Milic EJ, Mead J, Turner JM, Glauser EM (1964) Improved technique for estimating pleural pressure from esophageal balloons. J Appl Physiol 19:207–211

    Google Scholar 

  7. American Thoracic Society (1987) Single breath carbon monoxide diffusing capacity (Transfer factor): recommendations for a standard technique. Am Rev Respir Dis 136:1299–1307.

    Google Scholar 

  8. Cotes JE (1993) Lung function, 5th edn. Blackwell, Oxford, pp 445–513

    Google Scholar 

  9. Hida W, Taguchi O, Kikuchi Y, Shirato K, Takishima T (1992) P wave height during incremental exercise in patients with chronic airway obstruction. Chest 102:23–30

    Article  CAS  PubMed  Google Scholar 

  10. Elliott CG, Cromar B, Adams TD, Crapo RO, Yeh MP, Gardner RM (1987) Measurement of anaerobic threshold in chronic airflow obstruction. Respiration 52:7–15

    Article  CAS  PubMed  Google Scholar 

  11. Fletcher CM, Elmes PC, Fairbairn AS, Wood CH (1959) The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J 2:257

    Article  CAS  PubMed  Google Scholar 

  12. Wakabayashi A (1995) Thoracoscopic laser pneumoplasty in the treatment of diffuse bullous emphysema. Ann Thorac Surg 60:936–942

    Article  CAS  PubMed  Google Scholar 

  13. Cooper JD, Trulock EP, Triantafillou AN, Patterson GA, Pohl MS, Deloney PA, Sundaresan RS, Roper CL (1995) Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 109:106–119

    Article  CAS  PubMed  Google Scholar 

  14. Keenan RJ, Landreneau RJ, Sciurba FC, Ferson PF, Holbert JM, Brown ML, Fetterman LS, Bowers CM (1996) Unilateral thoracoscopic surgical approach for diffuse emphysema. J Thorac Cardiovasc Surg 111:308–316

    Article  CAS  PubMed  Google Scholar 

  15. McKenna RJ, Brenner M, Gelb AF, Millin M, Singh N, Peters H, Panzera J, Calmese J, Schein MJ (1996) A randomized, prospective trial of stapled lung reduction versus laser bullectomy for diffuse emphysema. J Thorac Cardiovasc Surg 111:317–322

    Article  PubMed  Google Scholar 

  16. Sciurba FC, Rogers RM, Keenan RJ, Slivka WA, Gorcsan J III, Ferson PF, Holbert JM, Brown ML, Landreneau RJ (1996) Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema. N Engl J Med 334:1095–1099

    Article  CAS  PubMed  Google Scholar 

  17. Little A, Swain J, Nino J, Prabhu RD, Schlachter MD, Barcia TC (1995) Reduction pneumoplasty for emphysema: early results. Ann Surg 222:365–374

    Article  CAS  PubMed  Google Scholar 

  18. Eugene J, Ott RA, Gogia HS, Santos CD, Zeit R, Kayaleh RA (1995) Video-thoracic surgery for treatment of end-stage bullous emphysema and chronic obstructive pulmonary disease. Am Surg 10:934–936

    Google Scholar 

  19. Sawabata N, Nezu K, Tojo T, Kawachi K, Kitamura S (1995) Morphological examination of the lung tissue ablated with Nd: YAG laser for the treatment of bullous pulmonary disease (in Japanese with English abstract). Nippon Kyobu Geka Gakkai Zasshi (J Jpn Assoc Thorac Surg) 43:831–835

    CAS  PubMed  Google Scholar 

  20. Hazelrigg S, Boley T, Henke J, Lawyer C, Johnstone D, Naunheim K, Keller C, Keenan R, Landreneau R, Sciurba F, Feins R, Levy P, Magee M (1996) Thoracoscopic laser bullectomy: a prospective study with three-month results. J Thorac Cardiovasc Surg 112:319–327

    Article  CAS  PubMed  Google Scholar 

  21. Kaiwa Y, Kurokawa Y, Ando K, Mori S (1995) Thoracoscopic laser treatment of pulmonary emphysema in a patient with decreased lung function after thoracotomy (in Japanese with English abstract). Nippon Kokyuki Geka Gakkai Zasshi (J Jpn Assoc Thorac Surg) 9:557–561

    Google Scholar 

  22. Pride NB, Barter CE, Hugh-Jones P (1973) The ventilation of bullae and the effect of their removal on thoracic gas volumes and tests of overall pulmonary function. Am Rev Respir Dis 107:83–98

    CAS  PubMed  Google Scholar 

  23. O'donnell DE, Webb KA, Bertley JC, Chau LKL, Conlan AA (1996) Mechanisms of relief of exertional breathlessness following unilateral bullectomy and lung volume reduction surgery in emphysema. Chest 110:18–27

    Article  PubMed  Google Scholar 

  24. Rogers RM (1970) Stress-relaxation in pulmonary emphysema and its relation to airway conductance. Am Rev Respir Dis 101:452–453

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery, Tohoku University School of Medicine, 1-1 Seiryo, Aoba-ku, 980-8574, Sendai, Japan

    Yoshihiro Kaiwa, Yoshimochi Kurokawa, Kenjiro Ando, Akihiko Nakagawa, Kazuhiro Mitsui & Susumu Satomi

  2. First Department of Internal Medicine, Tohoku University School of Medicine, 1-1 Seiryo, Aoba-ku, 980-8574, Sendai, Japan

    Hiroshi Miki, Hajime Kurosawa & Wataru Hida

Authors
  1. Yoshihiro Kaiwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshimochi Kurokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenjiro Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akihiko Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuhiro Mitsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Miki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hajime Kurosawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wataru Hida
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Susumu Satomi
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This study was supported in part by a grant from the Japanese Society for Advancement of Surgical Techniques

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kaiwa, Y., Kurokawa, Y., Ando, K. et al. Correlation of unilateral thoracoscopic lung volume reduction with improvement in lung function and exercise performance in patients with severe pulmonary emphysema. Surg Today 29, 718–723 (1999). https://doi.org/10.1007/BF02482315

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02482315

Key words

Search

Navigation