Video-Assisted Thoracic Surgery for Emphysema: Lung Volume Reduction Surgery, Concomitant Cancer Resection, and Volume Reduction Surgery and Bullectomy

  • Cliff K. C. ChoongEmail author
  • Julian A. Smith
  • Joel David Copper
  • Rolf G. C. Inderbitzi


Surgery for emphysema was first introduced by Brantigan and colleagues in 1957. It however did not gain acceptance due to high morbidity, mortality and a lack of objective results [1]. Cooper and colleagues at Washington University in St. Louis revived surgery for emphysema by reporting on their initial experience in 20 patients in 1995, and subsequently on the early outcomes (up to 2 years) in 150 patients in 1996, and the long-term outcomes (up to 5 years) in 250 patients in 2003 [2–4]. The surgery was termed as lung volume reduction surgery (LVRS). Cooper and colleagues showed that in appropriately selected patients, bilateral LVRS can produce significant functional improvement lasting at least 5 years for most of these patients and a low inhospital mortality rate of 4.8% [4]. The National Emphysema Treatment Trial (NETT) investigators confirmed the efficacy of bilateral LVRS over medical therapy in a prospective randomized multicentre study [5–7]. Lung volume reduction surgery for emphysema is now a proven therapy despite earlier concerns and controversies regarding the efficacy.


Wedge Resection Median Sternotomy Lung Volume Reduction Surgery Severe Emphysema Lung Cancer Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Brantigan OC, Mueller E (1957) Surgical treatment of pulmonary emphysema. Am Surg 23:789–804PubMedGoogle Scholar
  2. 2.
    Cooper JD, Trulock EP, Triantafillou AN et al (1995) Bilateral pneumonectomy (volume reduction) for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 109:106–119PubMedCrossRefGoogle Scholar
  3. 3.
    Cooper JD, Patterson GA, Sundaresan RS, Trulock EP, Yusen RD, Pohl MS, Lefrak SS (1996) Results of 150 consecutive bilateral lung volume reduction ­procedures in patients with severe emphysema. J Thorac Cardiovasc Surg 112:1319–1329PubMedCrossRefGoogle Scholar
  4. 4.
    Ciccone AM, Meyers BF, Guthrie TJ, Davis GE, Yusen RD, Lefrak SS, Patterson GA, Cooper JD (2003) Long-term outcome of bilateral lung volume reduction in 250 consecutive patients with emphysema. J Thorac Cardiovasc Surg 125:513–525PubMedCrossRefGoogle Scholar
  5. 5.
    The National Emphysema Treatment Trial Research Group (1999) Rationale and design of the National Emphysema Treatment Trial (NETT): a prospective randomized trial of lung volume reduction surgery. J Thorac Cardiovasc Surg 118:518–528CrossRefGoogle Scholar
  6. 6.
    Fishman A, Martinez F, Naunheim K, National Emphysema Treatment Trial Research Group (2003) A randomized trial comparing LVRS with medical therapy for severe emphysema. N Engl J Med 348:2059–2073PubMedCrossRefGoogle Scholar
  7. 7.
    Naunheim KS, Wood DE, Mohsenifar Z, Sternberg AL, Criner GJ, DeCamp MM, Deschamps CC, Martinez FJ, Sciurba FC, Tonascia J, National Emphysema Treatment Trial Research Group (2006) 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 82:431–443PubMedCrossRefGoogle Scholar
  8. 8.
    National Emphysema Treatment Trial Research Group (2001) Patients at high risk of death after LVRS. N Engl J Med 345:1075–1083CrossRefGoogle Scholar
  9. 9.
    Naunheim KS, Wood DE, Krasna MJ, DeCamp MM, Ginsburg ME, McKenna RJ, Criner GJ, Hoffman EA, Sternberg AL, Deschamps C, National Emphysema Treatment Trial Research Group (2006) Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial. J Thorac Cardiovasc Surg 131:43–53PubMedCrossRefGoogle Scholar
  10. 10.
    National Emphysema Treatment Trial Research Group (2004) Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery. J Thorac Cardiovasc Surg 127:1350–1360CrossRefGoogle Scholar
  11. 11.
    DeCamp MM, Blackstone EH, Naunheim KS, Krasna MJ, Wood DE, Meli YM, McKenna RJ, NETT Research Group (2006) Patient and surgical factors influencing air leak after lung volume reduction surgery: lessons learned from the national emphysema treatment trial. Ann Thorac Surg 82:197–207PubMedCrossRefGoogle Scholar
  12. 12.
    Sanchez PG, Kucharczuk JC, Su S, Kaiser LR, Cooper JD (2010) National Emphysema Treatment Trial redux: accentuating the positive. J Thorac Cardiovasc Surg 140:564–572PubMedCrossRefGoogle Scholar
  13. 13.
    Meyers BF, Sultan PK, Guthrie TJ, Lefrak SS, Davis GE, Patterson GA, Cooper JD, Yusen RD (2008) Outcomes after unilateral lung volume reduction. Ann Thorac Surg 86:204–211PubMedCrossRefGoogle Scholar
  14. 14.
    Waller D, Oey I (2009) Staged lung volume reduction surgery. Rationale and experience. Thorac Surg Clin 19:187–192PubMedCrossRefGoogle Scholar
  15. 15.
    Choong CK, Meyers BF, Battafarano RJ, Guthrie TJ, Davis GE, Patterson GA, Cooper JD (2004) Lung cancer resection combined with lung volume reduction in patients with severe emphysema. J Thorac Cardiovasc Surg 127:1323–1331PubMedCrossRefGoogle Scholar
  16. 16.
    Choong CK, Mahesh B, Patterson GA, Cooper JD (2009) Concomitant lung cancer resection and lung volume reduction surgery. Thorac Surg Clin 19:209–216PubMedCrossRefGoogle Scholar
  17. 17.
    Choong CK, Naylor J, Vuylsteke A, Hardy I, Screaton N, Porter JN, Davies M (2009) Successful combined bilateral lung volume reduction and coronary artery bypass grafting surgery: implications and advantages. J Thorac Cardiovasc Surg 137:1552–1554PubMedCrossRefGoogle Scholar
  18. 18.
    Choong CK, Agarwal A, Pulimood T, Screaton N, Hardy I, Vuylsteke A, Davies M (2009) Concomitant bilateral lung volume reduction surgery and aortic valve replacement: multidisciplinary strategies in achieving a successful outcome. J Thorac Cardiovasc Surg 137:1551–1552PubMedCrossRefGoogle Scholar
  19. 19.
    Choong CK, Schmid RA, Miller DL, Smith JA (2009) Combined cardiac and lung volume reduction surgery. Thorac Surg Clin 19:217–221PubMedCrossRefGoogle Scholar
  20. 20.
    Venuta F, Rendina EA, Coloni GF (2009) Endobronchial treatment of emphysema with one-way valves. Thorac Surg Clin 19:255–260PubMedCrossRefGoogle Scholar
  21. 21.
    Springmeyer SC, Bollinger CT, Waddell TK, Gonzalez X, Wood DE (2009) Treatment of heterogeneous emphysema using the Spiration IBV valves. Thorac Surg Clin 19:247–253PubMedCrossRefGoogle Scholar
  22. 22.
  23. 23.
  24. 24.
    Choong CK, Haddad FJ, Gee EY, Cooper JD (2005) Feasibility and safety of airway bypass stent placement and influence of topical mitomycin C on stent patency. J Thorac Cardiovasc Surg 129:632–638PubMedCrossRefGoogle Scholar
  25. 25.
    Choong CK, Phan L, Massetti P, Haddad FJ, Martinez C, Roschak E et al (2006) Prolongation of patency of airway bypass stents with use of drug-eluting stents. J Thorac Cardiovasc Surg 131:60–64PubMedCrossRefGoogle Scholar
  26. 26.
    Choong CK, Cardoso PFG, Sybrecht GW, Cooper JD (2009) Airway bypass treatment of severe homogenous emphysema: taking advantage of collateral ventilation. Thorac Surg Clin 19:239–245PubMedCrossRefGoogle Scholar
  27. 27.
    Shah PL, Slebos DJ, Cardoso PFG, on behalf of the Ease trial study group et al (2011) Bronchoscopic lung-volume reduction with Exhale airway stents for emphysema (EASE trial): randomised, sham-controlled, multicentre trial. Lancet 378:997–1005PubMedCrossRefGoogle Scholar
  28. 28.
    Van Allen C, Lindskog G, Richter H (1930) Gaseous interchange between adjacent lung lobules. Yale J Biol Med 2:297–300PubMedGoogle Scholar
  29. 29.
    Website airway bypass:
  30. 30.
    Monaldi V (1947) Endocavitary aspiration: its practical applications. Tubercle 28:223PubMedCrossRefGoogle Scholar
  31. 31.
    MacArthur AM, Fountain SW (1977) Intracavity suction and drainage in the treatment of emphysematous bullae. Thorax 32:668PubMedCrossRefGoogle Scholar
  32. 32.
    Goldstraw P, Petrou M (1995) The surgical treatment of emphysema: the Brompton approach. Chest Surg Clin North Am 5:777Google Scholar
  33. 33.
    Wakabayashi A (1993) Thoracoscopic technique for management of giant bullous lung disease. Ann Thorac Surg 56:708PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Cliff K. C. Choong
    • 1
    Email author
  • Julian A. Smith
    • 1
    • 2
    • 3
  • Joel David Copper
    • 4
  • Rolf G. C. Inderbitzi
    • 5
  1. 1.Department of Surgery (MMC), Monash Medical CentreMonash UniversityClayton, MelbourneAustralia
  2. 2.Department of Cardiothoracic SurgerySouthern Health, Monash Medical CentreClayton, MelbourneAustralia
  3. 3.Specialty ProgramSouthern Health, Monash Medical CentreClayton, MelbourneAustralia
  4. 4.Division of Thoracic SurgeryUniversity of Pennsylvania Health SystemPhiladelphiaUSA
  5. 5.Thoraxzentrum Zurich, Hirslanden ClinicZurichSwitzerland

Personalised recommendations