ABSTRACT
In the early days of thoracic surgery a variety of procedures were attempted to help patients with emphysema. These included tracheostomy, pneumoperitoneum, autonomic denervation, costochondrectomy, and bullectomy. Only bullectomy has survived as an effective operation for a small minority of patients with large emphysematous bullae. In 1950, Brantigan (1) introduced lung volume reduction, referred to as pneumoplasty, for patients with end-stage, generalized emphysema. He reported encouraging preliminary results, but the early mortality of 27% was high and the procedure was not adopted. It remained forgotten until the reintroduction of single lung transplantation in the 1980s. In a few instances where the hyperinflated, unoperated lung was found to be compressing the transplanted lung in the early postoperative stage, nonanatomical resection of a portion of the native lung proved life-saving (2). In 1991 Wakabayashi et al. (3) reported encouraging results following unilateral laser pneumoplasty via an endoscopic approach in 500 procedures performed on 443 patients. Unfortunately the study was flawed due to inadequate documentation of
objective measures of lung function and quality of life. In 1995 Cooper et al. (4) reported on bilateral lung volume reduction surgery (LVRS) in 20 patients in whom 20-30% of the volume of each lung had been removed through a midline sternotomy. The mean FEV1 improved by 20%, and total lung capacity (TLC), residual volume (RV), and trapped gas were significantly reduced.
