[Volume reduction surgery--a new treatment concept in advanced diffuse pulmonary emphysema].

Excision of large space occupying bullae in patients with emphysema is an accepted procedure if the underlying parenchyma is compressed and relatively normal. This operation may relieve symptoms of dyspnea and improve exercise tolerance. The volume reduction operation is based on different concept and designed for the diffuse type of emphysema. Resection of the most diseased lung in patients with marked hyperinflation may relieve thoracic distension and improve respiratory mechanics. We are currently evaluating prospectively the use of bilateral thoracoscopic volume reduction for patients with advanced, diffuse emphysema. During the last 1 1/2 years over 20 patients have been operated on. The average FEV1 was 765 ml/sec preoperatively and improved 40% within 3 months with a range of 0-100%. The 12 minute walking distance improved more than 100%. There was no perioperative mortality. Bilateral thoracoscopic volume reduction surgery is a palliative procedure but offers significant improvement in pulmonary function and exercise capacity for many patients.