Respiratory services offered by Saint Louis University Hospital and SLUCare physicians were ranked No. 25 among U.S. News & World Report’s “America’s Best Hospitals,” 2001.

Diagnosis and treatment for respiratory diseases are offered by a multidisciplinary team of physicians and support staff. Specialized care is provided for patients with lung cancer, acute respiratory failure and chronic obstructive pulmonary disease. Lung volume reduction surgery and lung transplantation evaluation are available, as is a pulmonary rehabilitation program to assist patients with chronic lung disease.

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Lung Volume Reduction Surgery
Saint Louis University School of Medicine is currently involved in a national study sponsored by Medicare and the National Institutes of Health (NIH). This study, which began in 1998, has been set up to determine the value of surgical treatment of patients with emphysema.

What is emphysema?
Emphysema is a disease usually caused by cigarette smoking, but it can also be seen in non-smokers, some of whom have a rare enzyme disorder called alpha 1 antitrypsin deficiency. In patients with emphysema, the tiny air sacs that make up the lung tissue have been destroyed. Normally these air sacs help to draw oxygen from the air into the blood stream and rid the body of carbon dioxide (a waste product). The walls of the tiny air sacs are broken down and this results in emphysema.

Why is surgery performed?
The reasoning for lung reduction surgery is to remove the most diseased portion of the lungs. This may allow for better lung function with more normal motion of the chest wall and diaphragm (breathing muscles). The air sacs in the surrounding tissue are no longer compressed, but open up to allow airflow so the exchange of oxygen and carbon dioxide may improve. In addition, once the most damaged parts of the lung have been removed, the rib cage and diaphragm may return to a more normal position, allowing for improved breathing motion. In this way, airflow into and out of the lung may be increased. This is called "lung volume reduction surgery" and is designed to improve the function of the lungs.

Does Medicare pay for this surgery?
Currently, Medicare does not pay routinely for this procedure. Medicare pays for the operation only at the 17 centers selected to participate in the NIH study. Patients must undergo an evaluation to determine whether this surgery might or might not benefit them. Patients selected for the Medicare study will be assigned to one of two groups. One group will undergo surgery, optimal medical therapy and a course of rehabilitation. The other group will undergo optimal medical therapy with rehabilitation. The assignment to one group or the other will be done randomly, a requirement for all 17 centers in order to participate in the study. Patients who are unwilling or unable to participate in the Medicare study may be considered for lung reduction surgery at Saint Louis University Hospital outside of the study. A number of private insurance companies cover this operation and other patients have decided to pay for the operation out-of-pocket.

How is the operation done?
The surgical approach offered by SLUCare physicians is called "video thoracoscopy." Three small incisions are made on each side of the chest and a combination telescope/TV camera is passed through an opening between the ribs. Surgical instruments are passed through the other two slits and surgery is performed inside the chest by the surgeon, who sees the lung on a TV monitor. The most diseased portion of each lung will be removed using a special stapling device. This is also called video assisted thoracic surgery (VATS).

What should I expect from this surgery?
The purpose of the surgery is to improve breathing. This may mean less shortness of breath during exercise and greater activity levels. In those patients already on oxygen, the improvement may be great enough to remove the need for oxygen. However, this surgery will not cure emphysema. Although the most damaged areas of the lung are removed, the lung left behind is still affected by emphysema. This means that the patient should not expect to stop medications and cannot resume smoking. Bronchodilators, antibiotics and other needed medications should continue after surgery. As part of the study, patients are required to be followed with periodic testing and rehabilitation for several years. Patients not participating in the NIH study should also expect both periodic testing and rehabilitation.