New and Emerging Minimally Invasive Techniques for Lung Volume Reduction: Thoracoscopic Techniques
Lausberg et al recently reported a method of radiofrequency-induced fenestrations in segmental bronchi to enhance expiratory airflow in emphysematous lungs. Twelve explanted emphysematous lungs removed during lung transplantation were studied in a ventilation chamber ex vivo. Three to five fenestrations were made in segmental or subsegmental bronchi adjacent to lung parenchyma with a radiofrequency catheter (Exhale RF Probe; Bronchus Technologies; Mountain View, CA) inserted via a fiberoptic bronchoscope. Patency of the bronchopulmonary fenestrations was maintained with uncovered coronary stents (3 mm in diameter, 15 mm in length). Mean FEV1 measured in the experimental pressurized ventilation chamber increased from 245 to 447 mL (83% increase, p < 0.001) following creation of the stented fenestration. In vivo animal studies of this procedure are underway.
Prolonged air leaks remain a common complication following LVRS. Most surgeons use bovine pericardial strips to buttress the staple line during LVRS.’’ Another method reported to minimize postoperative air leaks involved thoraco-scopic lung plication rather than standard resection for LVRS.
Swanson et al reported a method of plication involving grasping the involved portion of lung with a ring forceps, folding the tissue with a plication clamp, followed by stapling across the folded lung through four layers of visceral pleura. Thirty-two patients with emphysema (mean FEV1, 0.68 L; 22% predicted) were operated on in 50 procedures (14 unilateral and 18 bilateral). Two procedures (4%) were converted to open thoracotomy for air leak. Four other procedures (9%) were associated with prolonged air leaks (> 7 days). FEV1 increased by a mean of 29%, with 78% of patients showing an increase in FEV1.