Mayo Clinic surgeons performing lung volume reduction surgery for emphysema

Monday, February 14, 2005

JACKSONVILLE, Fla., Feb. 14, 2005 — Surgeons at Mayo Clinic in Jacksonville, Fla., are the first in the state performing a procedure called lung volume reduction surgery (LVRS) to treat certain patients with emphysema.

Emphysema is an irreversible and fatal lung disease that affects about 2 million Americans. Emphysema causes the tiny air sacs in the lungs, called alveoli, to lose their elasticity and ability to exchange oxygen. The damaged alveoli break down and form larger sacs that retain air. This less elastic, inflated and inefficient lung tissue fills up more space in the chest cavity. These hyperinflated lungs flatten the diaphragm, making it inefficient. As a result, breathing becomes increasingly difficult.

During LVRS, surgeons remove one-third to one-half of the upper lobe of each lung. They do this by either making an incision through the breastbone or through incisions on the patient's sides. With damaged lung tissue removed, the diaphragm returns to a more normal position and breathing is considerably eased.

"There are very few things we can offer patients with emphysema," says Mayo Clinic pulmonologist Dr. Joseph Kaplan. "LVRS offers the chance to greatly improve a patient's tolerance for activity."

Thomas Ellenburg went from working on big diesel engines to needing his wife to bathe him. He was diagnosed with chronic emphysema in 1999. By 2003 he required oxygen around the clock. "My lungs had gotten so enlarged that whenever I would eat, my stomach would push up against my lungs, and I couldn't breathe," he says. "If I was a real panicky person, I don't think I could have handled it."

Resigned to a slow, miserable death, Ellenburg came to Mayo Clinic to see if there was anything that could be done to save his life. "I knew that was my last trip," he says. "If they couldn't do anything for me, I would die from chronic emphysema." It turned out that Ellenburg was a candidate for LVRS. He had the surgery in June 2004. Seven months later, he and his wife took the cruise they'd been dreaming of — without oxygen. "To be able to walk on and off that ship without the aid of oxygen was just fantastic," he says. "Not to have a tube stuck in my nose all the time, I can't even tell you how good that feels."

Mayo Clinic transplant pulmonologist Dr. Cesar Keller helps evaluate candidates for LVRS. "By the time these patients have lung volume reduction surgery, they are no longer responsive to medical therapy," he says. "There is nothing else to offer except a surgical approach. The other surgical approach is a lung transplant. A transplant will give patients a lot more lung function than LVRS, but that comes with a price. They have to be on immunosuppressive therapy with all the complications that can arise from that."

Keller participated in the National Emphysema Treatment Trial (NETT). This five-year, multicenter trial, supported by the National Heart, Lung, and Blood Institute and the Centers for Medicare & Medicaid Services, concluded in 2003. It helped determine which patients were good candidates, and more importantly, which patients weren't good candidates for LVRS.

To be considered a candidate for the surgery at Mayo Clinic, patients must meet criteria established by NETT. Those criteria include having disease predominately in the upper lobes of their lungs and remaining lung function of between 20 and 45 percent as measured by a special breathing test.

Before surgery, patients undergo six weeks of pulmonary rehabilitation that includes exercise therapy to prepare them for LVRS. Most patients are expected to remain in the hospital for about a week while they recover and resume rehabilitation and continued exercise therapy.

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Mayo Clinic is a multispecialty medical clinic in Jacksonville, Fla. The staff includes 318 physicians working in more than 40 specialties to provide diagnosis, treatment and surgery. Patients who need hospitalization are admitted to nearby St. Luke's Hospital, a 289-bed Mayo facility. Mayo Clinics also are located in Rochester, Minn., and Scottsdale, Ariz. Visit www.MayoClinic.org/news for all the news from Mayo Clinic.

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