German Thoracic Research Scholarship 1996: lung volume reduction for endstage pulmonary emphysema at the Washington University of St. Louis.

The Thoracic Research Scholarship 1996 of the German Society for Thoracic and Cardiovascular Surgery enabled me to visit Barnes Hospital at the Washington University of St. Louis, USA, from May to July 1996. At that center Prof. J. D. Cooper has established lung-volume reduction surgery as a successful surgical treatment for patients with endstage pulmonary emphysema. The operation is performed using left-sided double-lumen intubation. After opening of the chest and pleura and starting single-lung ventilation the less diseased parts of the second lung collapse due to absorption atelectasis whereas the more diseased portion of the lung stays hyperinflated. Linear staplers buttressed with bovine pericardium are used to resect the diseased parts of the lungs. Approximately 20-30% of the total lung volume can be resected by this way on each side. After inspection of the lungs for air leaks and preparation of pleural tents the pleura is closed bilaterally. Postoperative analgesia is performed via epidural catheter and patients are extubated postoperatively as soon as possible, usually in the operating theatre. 150 bilateral lung-volume reduction procedures for patients with severe emphysema were performed between January 1993 and February 1996 in St. Louis. 6 months postoperatively the 1-second forced expiratory volume had increased by up to 51% and residual volume was reduced by 28%. 70% of patients who required continuous oxygen supply prior to the operation no longer required this measure: the PaO2 had increased by an average of 8 mmHg. These data demonstrate that bilateral lung-volume reduction surgery is a suitable treatment for patients with terminal pulmonary emphysema. Most important for the success of this procedure are clear selection and specific perioperative treatment of the patients.