Nuwe operasie vir emfiseem


In September 2014 het dr. Johan Theron, longspesialis van Mediclinic Panorama, en prof. Coenie Koegelenberg van die Universiteit van Stellenbosch, die eerste dokters in Afrika geword om ‘n nuwe prosedure, bekend as die longvolumeverminderings-spiraal-prosedure, op ‘n pasiënt uit te voer. Die prosedure is baie duur, maar bring hoop vir beter asemhaling vir sommige emfiseem-lyers.

LUISTER NA DIE PROGRAM, SOOS UITGESAAI OP RSG OP 1 APRIL 2015.

Kyk na ‘n video met onderhoude met die pasiënte en die dokters en die prosedure. Klik hier.

Die spiraal word met dun buisie in die long geplaas.

Die spiraal word met dun buisie in die long geplaas.

Dr Johan Theron, intervensionele longspesialis by Mediclinic Panorama.

Dr. Johan Theron, intervensionele longspesialis by Mediclinic Panorama.

So lyk die spiraaltjie

So lyk die spiraaltjie

Coil3

Pasiënt gesels oor sy operasie.

Pasiënt gesels oor sy operasie.

Hier is Mediclinic se mediaverklaring, wat in Engels uitgereik is, vir meer inligting.

A ground breaking Lung Volume Reduction Coil (LVRC) Procedure set to bring relief to emphysema sufferers was performed at Mediclinic Panorama, making it a first for the African continent.

In a public private collaboration, Dr Johan Theron, pulmonologist at Mediclinic Panorama and Professor Coenie Koegelenberg of the University of Stellenbosch became the first doctors to use the procedure on two patients at the Heart and Lung Unit at Mediclinic Panorama. It provides hope for emphysema sufferers who have tried all other treatment options available to no effect.

Emphysema is a form of chronic obstructive pulmonary disease (COPD) which is the fastest growing cause of death in developed world economies, and is currently the fourth most frequent cause of death worldwide. People with emphysema experience shortness of breath and difficulty breathing, which can worsen with exercise or even when performing daily routine activities, through a deficit in elasticity in the pulmonary tissue. The loss of elasticity presents a major problem in emphysema management.

Although the procedure was first performed in September 2014, it was necessary to set up all the required infrastructure for these procedures, ensure that sufficient after-care support is in place for patients and conduct a sensible number of procedures before announcing it publically.

“This new procedure increases pulmonary elasticity by inserting a number of tiny coils into the lungs to hold open narrow airways, preventing them from collapsing and improving the lung’s capacity to contract when breathing out,” explains Dr Theron. “Although the procedure lasts about an hour under general anaesthesia or deep sedation, the resultant improvement in lung function can be tested within a day, and a patient without complications can be discharged after two days.”

The coils used in the procedure are imported from Germany and the cost of the LVRC procedure is between R350,000 and R400,000 for two full implantations. While it is not low-priced, the cost is very much on par with other endoscopic procedures in South Africa such as the insertion of endobronchial valves and surgical lung volume reduction.

Mr Rob Faux (64), a patient from Johannesburg, was suffering from Chronic Obstructive Pulmonary Disease (COPD) and started developing severe emphysema. He looked into options for treatment, but was not prepared to go for surgery and started researching alternatives. He then read about the Lung Volume Reduction Coil (LVRC) procedure that is non-invasive and non-surgical. He was well on his way to have this done in Germany when he discovered that Dr Theron at the Mediclinic Panorama Heart and Lung Unit right here could perform the procedure in Cape Town.

“Due to the condition, even basic activities like going to the shops, or going to an upstairs level to watch a movie at a shopping centre was too much for me. I’ve done my own research and according to information from overseas, the real impact of this procedure is only measured around three to six months after. However, I could feel a significant improvement immediately after just one of my lungs was done. Now the procedure has been completed on both my lungs, and if it is going to get even better than this, I am absolutely elated.”

Mediclinic is proud to be associated with the pioneering work carried out by specialists of the calibre of Dr Theron and Professor Koegelenberg and their team; in line with the hospital group’s brand promise of Expertise you can Trust.

The Mediclinic Panorama / Stellenbosch University location is currently the only site in the whole of Africa that is accredited to perform the LVRC procedure. It is also the first outside of the USA and Europe. What makes Mediclinic Panorama Heart and Lung Unit unique is that it offers state-of-the-art technology and an enabling environment for its group of heart and lung specialists to collaborate with academic colleagues. As a result, a number of highly specialised therapies for the most difficult-to-treat patients are often innovated here.

Many other revolutionary interventional procedures have already been developed from the Mediclinic Panorama / Stellenbosch University location. These include the likes of the endobronchial ultrasound with transbronchial nodal aspiration, transthoracic ultrasound guided biopsies and more recently, the endobronchial vagal ablation.

FACT SHEET ABOUT THE PROCEDURE
A groundbreaking Non-surgical procedure namely Lung Volume Reduction Coil (LVRC) procedure that brings new hope to patients who suffer from severe emphysema or Chronic Obstructive Pulmonary Disease (COPD) was performed at Mediclinic Panorama Heart and Lung Unit. It is also a first on the African continent. In a public private collaboration, Dr Johan Theron, pulmonologist at Mediclinic Panorama and Professor Coenie Koegelenberg of Stellenbosch University became the first doctors to use the LVRC procedure on patients at the Heart and Lung Unit at Mediclinic Panorama. Professional Nurse Ansunette van der Walt, who had to receive intense training prior to the procedure, supported them.

The procedure was first performed on 16 September 2014. Mediclinic first wanted to set up all required infrastructure to do these procedures, ensure that the necessary after-care support is in place for patients and conduct a sensible number of procedures before going public with it. This is in line with Mediclinic’s clinical approach and general patient care approach of Expertise that you can Trust. A total of six procedures have since been executed with a 100% success rate on three patients (two each). The patients are all doing remarkably well, with no significant complications.

Emphysema is defined by abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanied by destruction of the airspace walls, without obvious fibrosis (i.e. there is no fibrosis visible to the naked eye). In simple terms, it is when the lung tissue is compromised; and the normal spongy air sacs are destroyed and replaced by damaged and enlarged air sacs that are difficult to deflate. This causes air to get trapped in the chest.
COPD is a collection of subtypes of lung diseases that includes chronic obstructive airways disease or chronic obstructive asthma, chronic bronchitis and emphysema. In people with COPD, the airways (the branching tubes that carry air within the lungs) become narrow and damaged and cause airflow limitation.

The condition of both patients with emphysema and COPD affects their quality of lives as they experience shortness of breath or difficulty in breathing, which in turn makes them tired. This not only worsens during physical exercise, but also during basic daily routine activities. These patients also wheeze (make a whistling or squeaking noise as they breathe), cough and spit up phlegm (mucus).

This pioneering LVRC procedure increases pulmonary elasticity through the insertion of a number of tiny coils into the lungs to hold the narrow airways open. It also prevents it from collapsing, decreases the amount of air trapped and improves the lungs’ capacity to contract when breathing out.
One of the elements that make the procedure unique is that unlike surgery or other interventions (e.g. endobronchial valves), it can be used in most subtypes of Emphysema.

The key benefits of the LVCR procedure can be summarised as follows:
a. The lungs “shrink” back to a smaller size, allowing patients to breathe easier, almost instantly.
b. The procedure is non-invasive.
c. Only general anaesthesia is required.
d. The procedure takes only 30 – 60 minutes to perform.
e. Patients generally just stay in hospital for one day.
f. The procedure will have an effect on the patient almost immediately.
g. No specific rehabilitation is required.
h. At least three out of four will experience a significant improvement.
i. To date, the procedure has had no negative repercussions for any patients.
The first pilot study on the LVRC procedure was done in 2008 and it has since successfully been performed in other countries in the rest of the world such as the USA, Germany, Switzerland, Spain, The Netherlands and France. There is a small risk of infections, exacerbations of their emphysema and collapse of the lung, but to date, no significant negative effects on patients have been recorded. The long-term sustainability cannot yet be confirmed as only a few thousand patients have received this treatment over the last couple of years.

The LVCR procedure was originally initiated by Professor Chris T Bolliger (former professor in Pulmonary Medicine at Stellenbosch University and the Tygerberg Academic Hospital), Dr Johan Theron (Pulmonologist at Mediclinic Panorama) and Professor Coenie Koegelenberg of Stellenbosch University. After the passing of Prof Bolliger, Dr Theron and Prof Koegelenberg continued with negotiations and set up a local firm to import the coils that are needed for the procedure.

Both Dr Theron and Prof Koegelenberg were trained by the late Prof Chris Bolliger, former professor who was renowned for being a leader in the field of interventional Pulmonology. Also in 2010, for his achievements in the field of Pulmonology, he was awarded a Lifetime Achievement Certificate at the World Congress for Bronchology in Budapest, Hungary, where he delivered his honorary lecture on the staging of lung cancer (Source: SA Respiratory Journal Volume 18, Issue 4).

Mediclinic Panorama – Stellenbosch University location is currently the only site in the whole of Africa that is accredited to perform the LVRC procedure. It is also the first outside of the USA and Europe.
What makes Mediclinic Panorama Heart and Lung Unit unique – is that it offers state-of-the-art technology and an enabling environment for its group of heart and lung specialists to collaborate with academic colleagues. As a result, a number of highly specialised therapies for the most difficult-to-treat patients are often innovated here.

The many other revolutionary interventional procedures that have already been developed from Mediclinic Panorama – Stellenbosch University site- are a firm testimony to that. This includes the likes of Endobronchial ultrasound with transbronchial nodal aspiration, transthoracic ultrasound guided biopsies and more recently, the endobronchial vagal ablation.

According to the Burden of Obstructive Lung Disease (BOLD) study that can be found at www.boldstudy.org, just in Cape Town alone, 23.8% of adults over 40 years of age in suffer from this condition. It is also rife in South Africa, due to the kind of occupational hazards that exist in our country.

LVRC procedures cannot logically be expected in the public sector in the short-term though, but it should make its way into it eventually, due to the many technological advances that are currently taking place. In the meantime, to increase the number of specialists who are able to perform this treatment in South Africa, Mediclinic is training young specialists in the field in Interventional Pulmonology at the Tygerberg Academic Hospital (University of Stellenbosch). Interventional pulmonologists should generally be trained one on one; then observe at least five procedures, where after they should perform approximately 10 under supervision. This is in line with Mediclinic’s clinical approach and general patient care approach of Expertise that you can Trust.

For the most effective treatment of emphysema or COPD patients, LVRC procedures should be considered as an adjuvant to other medical therapies such as inhalers. It cannot be considered as first line therapy and patients have to be on optimal therapy already, before they qualify for the procedure.
As the coils are imported from Germany, the cost of the LVRC procedure is ± R350,000 to R400,000 for two full implantations. Even though it is certainly not low-priced, the cost is very much on par with other endoscopic procedures in South Africa such as the insertion of endobronchial valves and surgical lung volume reduction.

MORE ABOUT THE SURGEONS

Dr Theron and Prof Koegelenberg both qualified at the University of Stellenbosch and the Colleges of Medicine of South Africa. Dr Theron has been practising at Mediclinic Panorama and his qualifications are: MBChB (Stellenbosch University (South Africa) 1996, MMed (Int) (Stellenbosch University (South Africa) 2002 and Cert Pulm (SA) (Colleges of Medicine of South Africa) 2004. Prof Koegelenberg’s qualifications are: MBChB (cum laude) (Stellenbosch University) 1995, MMed (Int) (cum laude) (Stellenbosch University) 2000, FCP (SA) Colleges of Medicine of South Africa 2001, MRCP (UK) (Royal College of Physicians (London) 2004, Cert Pulm (SA) (Colleges of Medicine of South Africa) 2006, PhD (Int Med) (Stellenbosch University) 2011 and FRCP (London) (Royal College of Physicians 2014.

Collectively, they have more than 40 publications in the field of interventional pulmonology, and will most definitely publish their current findings as well, as soon as an adequate numbers of patients have been treated.

Professor Coenie Koegelenberg’s research interests include infectious and pleural diseases, preoperative assessment of lung resection candidates and applied transthoracic ultrasound and interventional pulmonology. Personally, he is the author of more than 60 peer-reviewed papers and 10 textbook chapters, most on transthoracic ultrasound, pleural and infectious diseases.  He completed a PhD in 2011, and is currently involved with numerous studies. He has been an invited speaker to numerous national and international congresses (including ATS 2014 and Chest 2015). He is involved with the teaching of ultrasound skills to trainees in Medicine, and more advance skills (including bronchoscopy with EBUS and TBNA and thoracoscopy) to fellows in Respiratory Medicine. He is also an executive council member of the South African Thoracic Society (SATS) and one of the founding members and current chairman of Interventional Pulmonology South Africa (IPSA), which aims to improve the quality of interventional pulmonology in South Africa and to train as many pulmonologists as possible in the various techniques. Moreover, it is in the process of drawing up national guidelines for endobronchial lung volume reduction and bronchothermoplasty.

Dr. Johan Theron is a clinician working in Respiratory and Critical Care Medicine at Mediclinic Panorama.  After completing his training in Internal Medicine at Stellenbosch University (2002), he continued further training in Respiratory Medicine (supervised by the late Chris Bolliger), and was appointed as a consultant in Respiratory and Critical Care Medicine at Tygerberg Academic Hospital (Cape Town) in 2003.  He completed his training in Respiratory Medicine in 2004.  In 2005 he started in Private practice at Mediclinic Panorama. His research interests include infectious and pleural diseases, applied transthoracic ultrasound and interventional pulmonology.  Johan Theron is co-author of 10 peer-reviewed papers and one book chapter.  He has been an invited speaker to numerous national congresses.  He has been involved as faculty member at 3 Interventional Pulmonology courses. Dr. Theron has extensive experience in Interventional Pulmonology especially with endobronchial laser resection, airway stenting, TBNA, EBUS, Medical Thoracoscopy and treatment of benign airway stenosis.  He is involved with the teaching of advance skills to fellows in Respiratory Medicine.  He is also an executive committee member and one of the founding members of Interventional Pulmonology South Africa (IPSA), which aims to improve the quality of interventional pulmonology in South Africa and to train as many pulmonologists as possible in the various techniques.  Moreover, it is in the process of drawing up national guidelines for endobronchial lung volume reduction.