Synchronous Video-Assisted Thoracoscopic Fissure Closure and Endoscopic Lung Volume Reduction Using Endobronchial Valves in a Patient with Less Than 20% Fissure Completeness: A Case Report

Abstract: Endoscopic lung volume reduction (ELVR) using endobronchial valves (EBV) is an effective treatment for selected patients with severe emphysema and hyperinflation. However, its success relies on the absence of collateral ventilation (CV), typically requiring complete interlobar fissures. We report a unique case of a single-session combined surgical and ELVR approach in a patient with severe homogeneous emphysema fissure completeness below 20% on the left side. Intraoperative Pulmonary Assessment System (Chartis ® , Pulmonx, Redwood City, CA, USA) confirmed the presence of CV before, and its absence after surgical stapling of the interlobar fissure by video-assisted thoracoscopic surgery (VATS). The immediate postoperative course was uneventful. Postoperative chest imaging revealed atelectasis of the left lower lobe, resulting in improved quality of life, pulmonary function, and exercise capacity. This case suggests the potential feasibility and clinical benefit of a combined VATS-ELVR approach in well-selected patients with markedly incomplete fissures, when performed in experienced centers. Keywords: COPD, combined VATS-ELVR, VATS inter-lobar fissure completion, collateral ventilation, case report