Awake non-resectional lung volume reduction surgery

Lung Volume Reduction Surgery (LVRS) is now a well established procedure, which can considerably improve dyspnea, pulmonary function, exercise capacity, quality of life and survival in selected patients with severe emphysema, particularly when the upper lung lobes are predominantly involved. The standard operation entails unilateral or bilateral, staple non-anatomical resection of the most emphysematous lung tissue, carried out by median sternotomy or thoracoscopic approaches through general anesthesia and single-lung ventilation (resectional LVRS). Operative mortality and morbidity of resectional LVRS have been higher than those observed following the majority of other thoracic surgery procedures. It seems reasonable to assume that, in anatomically and physiologically fragile subjects such as candidates to LVRS, determinants of operative mortality and morbidity may include not only the surgical trauma deriving from resection of emphysematous lung tissue, but also general anesthesia. We have developed a non-resectional LVRS method that can be carried out through sole thoracic epidural anesthesia in fully awake patients. This technique has proved to offer lower morbidity and clinical benefits that paralleled those of resectional LVRS.