With proper patient selection excluding collateral ventilation, bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) offers significant benefits but increases pneumothorax risk. Prioritized management of persistent pneumothorax post-BLVR remains unclear, with both EBV removal and video-assisted thoracic surgery (VATS) considered options. We report a 76-year-old man with severe emphysema who developed persistent pneumothorax and subcutaneous emphysema after left upper lobe BLVR. Following the patient's wishes, VATS was performed instead of EBV removal, resulting in a favorable outcome without delaying BLVR benefits. Depending upon the situation and patient wishes, prioritizing VATS over valve removal may be a reasonable strategy.
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Sakaguchi et al. (2025) studied this question.