Lung Volume Reduction Surgery

Lung volume reduction surgery (LVRS) is a procedure designed to help you breathe easier when your lungs have been damaged by severe COPD. The goal of the surgery is to remove the area of the lung most affected by disease, allowing the remaining lung to function more efficiently, and improve your breathing ability and quality of life.

LVRS is not a recommended treatment for all patients with COPD. The best candidates for successful surgery tend to be those who:

• Have severe lung damage (emphysema), particularly in the upper part of the lung
• Are younger than 75 to 80 years old
• Have not smoked for at least six months
• Are not able to exercise well after completing pulmonary rehabilitation

What to Expect?

Before undergoing LVRS, patients must be evaluated by a pulmonologist and thoracic surgeon. Required pre-operation testing includes pulmonary function tests, six-minute-walk test, arterial blood gas, CT scans of the lungs, electrocardiography (ECG), echocardiogram and cardiopulmonary exercise test (exercise test performed on a treadmill or stationary bike to assess cardiac and pulmonary function).

The surgery is done under general anesthesia, which means you are completely asleep and placed on a breathing machine. There are several different techniques that may be used for this surgery. In a median sternotomy, the surgeon makes an incision through skin and bone in the middle of the chest to get to the lung. Another approach is using video-assisted thoracoscopy, where the surgeon makes multiple small incisions on both sides of the chest and uses video and surgical instruments to perform the surgery. Another technique, called a thoracotomy, involves making an incision between the ribs on the side of the chest and separating the ribs to get access to the lungs.

After surgery, post-operation time in the hospital will depend on your underlying health and any possible complications that may happen during surgery.

What Are the Risks?

The most common complications to these procedures are air leaks, where air continually escapes from the lung into the chest cavity. A chest tube will drain escaping air from your body and most air leaks will heal in seven days, but some patients have longer periods of air leak and may need a second surgery to remedy. Other complications could include the need for a breathing machine, pneumonia and blood clots. Less common complications are wound infection, heart attack, irregular heart rhythm and death.