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(Chest. 2004;125:777-783.)
© 2004 American College of Chest Physicians

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction*

Roger A. Maxfield, MD, FCCP

* From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians & Surgeons, New York, NY.

Correspondence to: Roger A. Maxfield, MD, FCCP, Columbia Presbyterian Eastside, 16 East 60th St, Suite 320, New York, NY 10022-1002; e-mail: ram7{at}columbia.edu

Lung volume reduction surgery (LVRS) has been shown to improve pulmonary function, exercise capacity, quality of life, and survival in selected patients with heterogeneous emphysema. However, LVRS is a major surgical procedure with potential morbidity and mortality. Minimally invasive techniques are emerging to achieve lung volume reduction without open thoracotomy. Devices and techniques under study include one-way bronchial valves inserted via fiberoptic bronchoscopy to promote atelectasis in emphysematous lung, promotion of focal atelectasis and fibrosis by bronchoscopic injection of polymers into emphysematous regions of lung, bronchopulmonary fenestrations to enhance expiratory flow, and thoracoscopic plication or compression of emphysematous lung. The goal of all of these procedures is to replicate the benefit of LVRS without the trauma, risks, and extended recovery of open LVRS. Refinement and application of these techniques will allow patients with emphysema and their physicians and surgeons to choose from a number of viable options for lung volume reduction.

Key Words: bronchoscopy • COPD • emphysema • endobronchial valve • interventional bronchoscopy • lung volume reduction • lung volume reduction surgery • minimally invasive • thoracoscopy




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