New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: Sternotomy

Iwasaki et al described another method of tho-racoscopic plication involving stapling across the apex of the lung, folding the lung at the staple line, and then restapling across the fold, holding the lung in a folded position. Twenty patients with emphysema had unilateral thoracoscopic lung reduction by this method of fold plication. Postoperative air leak lasted 0 to 5 days (1.7 days). FEV1 increased from 24.2 to 42.4% predicted with improvement in dyspnea in all patients. One patient had a spontaneous pneumothorax on day 7. Link

Air leaks have not been eliminated following LVRS with either bovine pericardium or lung plication. Use of a novel, vacuum-assisted, implantable elastomer device for lung reduction has been reported in animals with emphysema. Emphysema was induced in rabbits with nebulized elastase three times over 4 weeks. Development of emphysema was confirmed histologically and by increases in FRC and compliance. Twenty rabbits with emphysema had median sternotomy. Ten of the rabbits underwent lung reduction performed by applying suction to an elastomer sleeve in contact with the emphysematous lung. Lung tissue was drawn into the sleeve and held in place with a proximal purse string suture and distal sutures through the device and the reduced lung. There were no air leaks in any of the animals after the operation. FRC and compliance both decreased in the animals who underwent the lung reduction procedure, and did not change in the animals who underwent sternotomy without lung reduction. Fluorescent microsphere injections in the treated rabbits demonstrated decreased blood flow to the reduced lung tissue as well.
Similar results with vacuum-assisted lung reduction were obtained in a study of dogs with papain-induced emphysema. Emphysema was confirmed by significant increases in TLC, FRC, and RV, with significant reduction in all three measurements at 1 month and 6 months following lung reduction. There were no air leak complications. Extreme reduction in blood flow to the reduced areas of lung was demonstrated with fluorescent microsphere in-jections.