CURRENT STATUS OF LUNG-VOLUME REDUCTION OPERATIONS FOR EMPHYSEMA

In the 1990s, the concept of surgical therapy was introduced once agai n for the treatment of end-stage emphysema. The earliest reports toute d laser ablation of emphysematous lung as definitive therapy. Although some discernable benefit was reported, this was associated with signi ficant operative morbidity. In 1993, the concept of parenchymal resect ion or ''lung volume reduction'' was reintroduced as treatment for end -stage lung disease. Over the ensuing 3 years, different techniques an d approaches have evolved at different institutions. Lung volume reduc tion has been performed bilaterally and unilaterally through multiple approaches including sternotomy, thoracotomy, and thoracoscopy. The re sults of these various approaches are reviewed and compared. Lung volu me reduction appears to be a beneficial procedure when performed in ca refully selected patients by personnel and at institutions that are ex perienced in the care of patients with end-stage emphysema.