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.
Keywords: Emphysema, VATS, LVRS.
