An interventional study of Interlobar fissure completion and pleural adhesiolysis in Emphysema or COPD, sponsored by Beth Israel Deaconess Medical Center. Recruiting at 1 site in United States. Open to participants aged 40 Years to 75 Years. Per ClinicalTrials.gov, last updated 2026-08-28.
Sponsored by Beth Israel Deaconess Medical Center · Not applicable, Interventional, and Treatment
The purpose of this protocol is to perform a pilot prospective controlled clinical trial to evaluate the potential role of lung fissure completion with pleural adhesiolysis strategy (experimental intervention) in severe emphysema/COPD patients with failed bronchoscopic lung volume reduction (BLVR) via the use of endobronchial valves (EBVs) therapy. In select patients, the lung fissure completion with adhesiolysis strategy will be performed by video-assisted thoracoscopic surgery (VATS) guided stapling along the lung fissures to reduce collateral ventilation with adhesions removal and determine whether this experimental strategy will improve outcomes after failed BLVR in patients with severe emphysema/COPD.
The investigators will approach all patients with failed EBV therapy. Patients with less than 350 ml of volume reduction in the target lobe and persistent dyspnea [score greater or equal to 2 on the Modified Medical Research Council Dyspnea Scale (mMRC)] after EBV placement will be considered to have failed EBV therapy due to adhesions or collateral ventilation being present. Only patients with failed EBV therapy will be approached to participate in our study. Once the patient agrees to participate and sign the consent, all the screening information collected as part of the standard of care will be extracted retrospectively from the medical records including appointment details, 6MWD, and PFTs results. In addition, during the same visit, health-related quality of life will be measured using the Saint George Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT), and dyspnea will be assessed with the self-reported mMRC.
VATS Inter-Lobar Fissure Completion and Pleural Adhesiolysis The clinician providing general anesthesia will be familiar with thoracic anesthesia and complications in patients with severe COPD undergoing thoracic surgery and endoscopic valve implantation. Total IV anesthesia will be used during all bronchoscopic procedures. Routine antimicrobial prophylaxis will be administered at induction. The antimicrobial choice will be based on the subject's allergies and/or history of resistant organisms.
The experimental procedure will be performed via VATS under inhaled anesthetic agents by an experienced thoracic surgeon from BIDMC. The clinician providing general anesthesia will be familiar with thoracic anesthesia and complications in patients with severe COPD undergoing thoracic surgery and endoscopic valve implantation. A double-lumen endotracheal tube will be inserted allowing one-lung ventilation and the maximal collapse of the operative lung. The subject will be placed in lateral decubitus with the operative side up. Disinfection of the surgical site will be performed with the application of an antiseptic solution and the subject will be draped in the usual sterile fashion. The thoracic surgeon will perform multiple rib blocks and inject the skin incisions with bupivacaine. Through small incisions, the surgeon will create a camera port through the intercostal space and then the anterior and posterior inferior ports. Electrocautery will be used for adhesion release of the ipsilateral lung of the target lobe. Dissection and exposure of the anterior aspect of the hilum will then be performed using electrocautery. Following the exposure, stapling will be performed on the incomplete fissure adjacent to the target lobe, using the Endo GIATM (CovidienTM, Mansfield, MA) FDA-approved surgical stapler. The lung tissue will be dissected until the pulmonary artery is seen, in a similar fashion to the method used in lobectomies and segmentectomies. Multiple surgical stapler activations will be used to complete the target fissure along the fissure line.
An attempt at conversion to a complete fissure will be made, though depending on the anatomy, it may be possible that residual incomplete fissure of up to 5% may be tolerated. Hemostasis will be evaluated. Sterile water will then be used to fill the surgical area, followed by lung inflation and inspection to verify for air leaks at the level of the stapling. If an air leak is detected, suturing, re-stapling, or applying pleural sealants will be used to seal it. The patient will be monitored closely for air leaks in the postoperative setting in case there is the persistence of the air leak despite the measures taken and valve presence, a second intervention will be considered based on the thoracic surgeon's judgment. Once the fissure is surgically completed, a chest tube will be placed and connected to a chest drainage system.
In the setting that the thoracic surgeon will not be able to complete the fissure up to 95% due to anatomic restraints, the procedure will then be ended without valve implantation, as the presence of residual collateral ventilation is expected. All patients will receive standard of care post-operative management, and subjects will continue to be followed for any procedure-related adverse events until the event has subsided or, in case of permanent impairment, until the event stabilizes, and the overall clinical outcome has been ascertained. At that time, the subject will be withdrawn from the study and will be considered as an "Enrollment Failure" and recorded as such for statistical analysis.
Bronchoscopic Evaluation The double-lumen endotracheal tube will be removed, and a single-lumen tube (8.0 to 8.5 mm) inserted. The lung will be completely re-inflated before this evaluation to return them to normal anatomy.
Flexible bronchoscopy will be done by the interventional pulmonologist. The bronchoscope will be passed via the endotracheal tube and the major airways will be examined. The placement of the EBVs will be assessed. In case one of the valves is not adequately placed, the interventional pulmonologist will adjust it. If any valve needs to be replaced, the replacement will be performed at this point. A bronchial wash will be performed with samples sent for culture. If there are unexpected findings, such as a lesion suspicious for carcinoma or secretions suggesting infection, then appropriate clinical samples will be obtained, and the subject will be re-evaluated, the study team will then determine if the subject will be withdrawn from the study and will be considered as an "Enrollment Failure" and recorded as such for statistical analysis.
Postoperative Persistent Air-Leak Management In the setting of a persisting air-leak > 5 days after the procedure, the investigator will proceed to the removal of the most proximal valve from the treated lobe (if the left upper lobe is the treatment lobe, the removal will be from a lingular segment). If there is a resolution of the air leak within 48 hours, replacement of the valve will be considered and scheduled in 6 weeks. During the valve replacement procedure, if previously placed valves are observed to be sub-optimally placed, the investigator may remove and replace any sub-optimally placed valves.
If the air leak does not resolve within 48 hours after the first valve removal, all remaining valves will be removed. In the setting of a persistent air-leak despite previous interventions, further management will be based on the investigator's judgment and per standard of care (chemical pleurodesis or conservative management). Chest tube maintenance > 7 days in presence of a persistent air leak will also be considered as a thoracic serious adverse event and recorded in the AE CRF as part of the study's safety evaluation.
The management algorithm for persistent air-leaks was adapted from the expert consensus by Valipour et al. Clinical management of persistent air-leaks may vary depending on clinical circumstances, so exceptions to these guidelines will not be considered protocol deviations.
Pneumothorax Management Pneumothorax after valve placement can be an effect of the desired treatment response that is associated with complete lobe treatment and atelectasis. The management of pneumothorax is an integral part of the treatment. The origin is thought to be from the rupture of stretched diseased tissue that is adjacent to the volume reduced lobe. Management for pneumothorax associated with EBVs will be conducted according to expert consensus and our internal algorithm, which represents standard-of-care for pneumothorax management.
Follow-up Period After VATS fissure completion and adhesiolysis, patients will be placed on a standardized follow-up protocol used for individuals that underwent video-assisted thoracic surgery. Data from follow-up appointments at 14 days and 3 months will be collected from the medical records retrospectively including appointment details, complications, CT-scan results, 6MWD, and PFTs results. Target lung volume reduction (TLVR) will be assessed at 3 months using the CT scans performed on patients as part of their standard of care. The only procedures that will be considered research after the initial surgical intervention would be the measurement of health-related quality of life with the SGRQ and CAT, and dyspnea assessment with the self-reported mMRC at 3 months.
382 studies on the registry are indexed under Emphysema; 59 are open to participants now.
This study's planned enrollment of 20 is below the median of 60 across 245 interventional studies indexed under Emphysema.
Browse Emphysema studies →Beth Israel Deaconess Medical Center is the lead sponsor of 568 studies on the registry; 80 are open to participants now.
Of its 76 completed or terminated interventional studies of FDA-regulated products, 62 (82%) have results posted.
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.
Chronic obstructive pulmonary disease: long-term lung disease that makes it hard to breathe out, including emphysema and chronic bronchitis.
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.
Clinically significant
Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
COPD
Chronic obstructive pulmonary disease: long-term lung disease that makes it hard to breathe out, including emphysema and chronic bronchitis.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Platelets
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
LVEF (left ventricular ejection fraction)
The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Patients will undergo a VATS or robotic interlobar lung fissure completion with pleural adhesiolysis. After a 3 month follow-up period, patients will fill additional quality of life questionnaires including the St.George Respiratory Questionnaire, COPD Assessment tool, and the modified medical research council dyspnea scale. Pulmonary function testing and a high-resolution CT scan will be performed at the end of the 3-month postoperative follow-up.
Procedure: Interlobar fissure completion and pleural adhesiolysis
A video-assisted thoracic surgery or robotic approach will be used to perform pleural adhesiolysis and the lobar fissure adjacent to the previously targeted lobe during bronchoscopic lung volume reduction will be completed using a surgical stapler.
Prove that inter-lobar fissures can be completed to at least 95% in severe emphysema patients with previously failed bronchoscopic lung volume reduction
The investigators will determine that performing the surgery is feasible if the target inter-lobar fissure can be completed in at least 90% of the patients enrolled.
Time frame: 2 years
Incidence of severe adverse events
The investigators will actively monitor and record the severe adverse events that require any kind of additional intervention (medical or surgical) during and after the procedure. In case the treating physicians consider that the complications seen in patients outweigh the benefits obtained, the surgical technique will be revised and possible changes will be discussed.
Time frame: 2 years
Percentage of patients to achieve target lung volume reduction
Describe the percentage of patients that achieve target lung volume reduction of at least 350mL at three months after the procedure.
Time frame: 2 years
Percentage of patients with quality of life improvement
Describe the changes in quality of life based on three subjective questionnaires that will be given to patients at baseline and three months after the intervention.
Time frame: 2 years
Percentage of patients with significant changes in pulmonary function testing
Describe the changes in PFTs after the intervention.
Time frame: 2 years
Plan to share: No
Started May 2022 (actual). Primary completion is estimated for Dec 2026, 55 months after the start.
Of 40 non-industry interventional studies with no phase under Emphysema, half reached primary completion within 44 months of starting (the median), counting those still running; a quarter within 28 and three quarters within 58. This study's planned 55 months is above that.
Counting every sponsor, half of 60 studies reached it within 37 months; a quarter within 22 and three quarters within 56.
How these figures are worked out, and which studies are left out of them.
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