Rare lung surgery at University of Chicago Medical Center gives patients fresh air

October 30, 2006

Imagine never being able to catch a good breath.

Imagine that, no matter how hard you try, you always feel as if you've just run a marathon.

Luella Pates doesn't have to imagine. She remembers it. Because up until she underwent an uncommon surgery for emphysema last month, that was her life.

"But now I'm so excited," she said. "Now I'm about the best you can be." Getting to that point involved two years tied to an oxygen tank followed by two hours of a rare surgery that removed a portion of her lungs.

Only about 60 other medical centers nationwide perform what's called lung-volume reduction surgery (LVRS), and Pates recently underwent the procedure at the University of Chicago Medical Center.

In 2004, pulmonologist James West--Pates' doctor at the north suburban Glenbrook Hospital--told her that she needed to go on oxygen.

Healthy lungs inflate, filling with air from every breath, and then recoil as the person breathes out. For Pates, years of smoking ruined her lungs' ability to contract. They remained inflated "fully, like a balloon," said Wickii Vigneswaran, associate chief of Cardiac and Thoracic Surgery and director of the Lung Transplant Program at the University of Chicago.

Pates' emphysema had progressed so that she could barely move without her oxygen tank. In the mornings, she would wake up and go to the kitchen for breakfast, but would have to get her portable oxygen before she could even finish preparing her food.

Eventually, West referred Pates to Vigneswaran, who came to the Medical Center with several colleagues from Loyola University's lung transplant team in late 2005. West referred her because he knew--if Pates proved eligible after a series of blood and imaging tests--that Vigneswaran and his team were capable of and experienced enough to perform the type of lung surgery that no other hospital in Illinois could perform.

Vigneswaran said an entire thoracic team, like the one now at the Medical Center, is necessary because "you need the framework and expertise" that the specialized lung surgeons, pulmonologist, nurses and anesthesiologists provide.

In the 1990s, many hospitals performed the surgery without the framework, and Medicare (the nation's largest health insurance program with 40 million insured) halted payments. The organization wanted to know if the surgery actually made a difference in people's health--for better or worse. By all appearances, recovery was slower than with lung transplant, and roughly 10 percent of patients didn't survive long after surgery. To find out, Medicare initiated a study that concluded last year.

During LVRS, a minimally invasive surgery that lasts about two hours, surgeons remove less effective sections of the patient's enlarged lungs, giving the remaining sections room to expand and increasing efficiency. Vigneswaran said mortality rates tend to be higher with this surgery because the patient isn't receiving a completely new pair of healthy lungs. Instead, "they now have a bad lung that is kind of beat up. The benefit doesn't show up immediately," he said.

The possible adverse results didn't deter Pates. She had her first consultation with Vigneswaran in March 2006 and said he told her, "There is no guarantee."

"I was never afraid because [Vigneswaran and West] were confident when they talked about it. The only thing I was going to focus on was that I would come out the best I could come out," Pates said, adding that she probably would have had the surgery sooner, but switched insurance coverage and wanted to make sure the surgery would be covered.

Her recovery proved quick and unexpectedly painless. Pates was out of the hospital a week after the operation (and a week before her anticipated check-out date). She experienced only one instance of pain before Vigneswaran's team was at her side to adjust her medication levels. She had entered the hospital on Sept. 6 and left Sept. 14 after walking down the hallway, untethered from her oxygen tank.

Now at home, Pates can prepare her breakfast--cook the grits and eggs--and eat it, all without her oxygen tank. Vigneswaran encourages her to ween herself off the oxygen, to use her tank at night and to practice her breathing exercises.

One of those exercises includes a little plastic tube with three balls inside. Pates breathes into the tube and tries to keep the balls afloat using the strength of her own breath. When she first attempted the exercise after surgery, she struggled to keep one ball up. A month later, Pates said she can get two easily and works on the third at least 10 times a day.

Pates's recovery is a good sign for future lung-volume reduction surgeries. She once again relies on her own lungs while simultaneously freeing up a pair of healthy lungs for someone on the organ donation wait list. Meanwhile at the Medical Center, Vigneswaran and his team await funding approval for Medicare patients. And when that comes, perhaps LVRS will no longer be quite so uncommon.

The University of Chicago Medical Center
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Chicago, IL 60637
Phone (773) 702-6241 Fax (773) 702-3171