[Lung volume reduction surgery for emphysema: a unilateral or bilateral approach?].
BACKGROUND
Lung Volume reduction surgery (LVRS) is a recognized therapeutic option for patients presenting with severe and disabling pulmonary emphysema. Case selection is based upon clinical, morphological and functional criteria.


BACKGROUND
LVRS has shown promising results, with improvements in exercise capacity, pulmonary function and quality of life, in selected patients with severe and disabling emphysema. A variety of surgical techniques have been described. The procedure may be unilateral or bilateral, through a sternotomy or by a video-assisted thoracoscopic (VATS) technique. The controversial aspects of the surgical technique will be analysed and discussed in the following review.


CONCLUSIONS
A bilateral approach clearly offers a better functional improvement when compared to a unilateral procedure, however, the postoperative functional decline appears greater and more rapid after a bilateral procedure. A unilateral approach, with often less postoperative morbidity, allows the option to perform a future contra-lateral procedure in the event of further clinical or functional deterioration.


CONCLUSIONS
In selected cases LVRS is an effective treatment for severe pulmonary emphysema. Different surgical techniques have been described. Nowadays VATS is considered to be the technique of choice, with the option to carry out a future unilateral or bilateral procedure.
Pezzetta
E
E
Service de Chirurgie Thoracique et Vasculaire, CHUV, Lausanne, Suisse. Edgardo.Pezzetta@chuv.hospvd.ch
Vallet
C
C
El-Lamaa
Z
Z
Haller
C
C
Ris
H-B
HB
D006801:Humans; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000601:surgery*