Bronchoscopic Lung Volume Reduction as the Treatment of Choice versus Robotic-Assisted Lung Volume Reduction Surgery in Similar Patients with Emphysema – An Initial Experience of the Benefits and Complications

Abstract

Objective

There is an assumption that because EBLVR requires less use of hospital resources, offsetting the higher cost of endobronchial valves, it should therefore be the treatment of choice wherever possible. We have tested this hypothesis in a retrospective analysis of the two in similar groups of patients.

Methods

In a 4-year experience, we performed 177 consecutive LVR procedures: 83 patients underwent Robot Assisted Thoracoscopic (RATS) LVRS and 94 EBLVR. EBLVR was intentionally precluded by evidence of incomplete fissure integrity or intra-operative assessment of collateral ventilation. Unilateral RATS LVRS was performed in these cases together with those with unsuitable targets for EBLVR.

Results

EBLVR was uncomplicated in 37 (39%) cases; complicated by post-procedure spontaneous pneumothorax (SP) in 28(30%) and required revision in 29 (31%). In the LVRS group, 7 (8%) patients were readmitted with treatment-related complications, but no revisional procedure was needed. When compared with uncomplicated EBLVR, LVRS had a significantly longer operating time: 85 (14–82) vs 40 (15–151) minutes (p<0.001) and hospital stay: 7.5 (2–80) vs 2 (1–14) days (p<0.01). However, LVRS had a similar total operating time to both EBLVR requiring revision: 78 (38–292) minutes and hospital stay to EBLVR complicated by pneumothorax of 11.5 (6.5–24.25) days. Use of critical care was significantly longer in RATS group, and it was also significantly longer in EBV with SP group than in uncomplicated EBV group.

Conclusion

Endobronchial LVR does use less hospital resources than RATS LVRS in comparable groups if the recovery is uncomplicated. However, this advantage is lost if one includes the resources needed for the treatment of complications and revisional procedures. Any decision to favour EBLVR over LVRS should not be based on the assumption of a smoother, faster perioperative course.

Keywords:

• lung volume reduction
• lung volume reduction surgery
• bronchoscopic lung volume reduction
• endobronchial valve
• emphysema

Abbreviations

AL, Air Leak; ASA, American Society of Anesthesiologists; BLVR, Bronchoscopic Lung Volume Reduction; BMI, Body Mass Index; COPD, Chronic Obstructive Pulmonary Disease; CV, Collateral Ventilation; CRS, Care Record Service; DLCO, Carbon Monoxide Diffusion Capacity; EBLVR, Endobronchial Lung Volume Reduction; EBV, Endobronchial Valve; FEV1, Forced Expiratory Volume In One Second; FVC, Forced Vital Capacity; HDU, High Dependency Unit; HU, Hounsfield Units; ICG, Indocyanine Green; ITU, Intensive Care Unit; KCo, Carbon monoxide transfer coefficient; LOS, Length of Stay; LVRS, Lung Volume Reduction Surgery; MDT, Multidisciplinary Team; MRC, Medical Research Council; NETT, National Emphysema Treatment Trial; NIR, Near-Infrared; NHS, National Health Service; QCT, Quantitative Computed Tomography; RATS, Robot-Assisted Thoracoscopic Surgery; RV, Residual Volume; VATS, Video-Assisted Thoracic Surgery; SD, Standard Deviation; SP, Spontaneous Pneumothorax; SPECT, Single-Photon Emission Computed Tomography; TLC, Total Lung Capacity.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There is no funding to report.