![]() For this reason the NETT trial was designed ( 11, 12) however, due to a number of problems it was able to answer only partially the questions raised by the initial experience. We are now aware that LVRS allows a reliable improvement in selected patients but the initial experience showed a significant in-hospital mortality of 19% ( 10). The pathophysiological principles of this operation are quite easy to understand: the removal of the worse parts of the emphysematous lung helps to remodel the diaphragmatic and chest wall mechanics. ![]() In 1993, lung volume reduction surgery (LVRS) revitalized ( 8, 9). For this reason other options have been investigated. Lung transplantation is certainly a viable option for a selected group of patients ( 6) however, the reduced number of available donors and the recent introduction of the lung allocation score (LAS) for organ allocation ( 7) significantly reduces the chances for COPD patients to reach the time of transplant. Bullectomy is the only one that resisted up to now ( 5). Various surgical procedures have been proposed in the past: chostochondrectomy, thoracoplasty, phrenicectomy, pneumoperitoneum, pleural abrasion, denervation of the lung, glomectomy and many others ( 3, 4) although they showed positive immediate results, an objective and prolonged benefit was rarely obtained thus, they were progressively abandoned. ![]() For this reason there has been an increasing urge for surgical and nonsurgical treatment. Maximal medical treatment, although effective at the early stages of the disease, becomes limited when extensive alveolar destruction is the main cause of respiratory failure. Accepted for publication Sep 10, 2018.Ĭhronic obstructive pulmonary disease (COPD) affects approximately 1.8% of the population ( 1, 2) it is a leading cause of disability and death. Keywords: Emphysema lung volume reduction respiratory failure valves coils vapour ablation sealants
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