What Is Lung Volume Reduction Surgery?
Lung volume reduction surgery (LVRS) is a treatment for end-stage lung disease caused by emphysema. Emphysema is a type of chronic obstructive pulmonary disease (COPD) that causes shortness of breath and lung damage.
People with severe emphysema and end-stage lung disease have portions of their lungs that don’t work properly. In LVRS, a thoracic surgeon removes this damaged lung tissue.
LVRS is one treatment for people with severe emphysema. Other treatment options may include endobronchial valve placement or lung transplant.
LVRS vs. Endobronchial Valves
Doctors usually consider LVRS when endobronchial valve placement is not possible.
In endobronchial valve placement, an interventional pulmonologist puts a one-way valve in your lung. This valve redirects air flow through your healthy lung tissue.
Good candidates for endobronchial valves have complete breaks (fissures) between the upper and lower parts of their lungs. Air doesn’t flow to the diseased lung tissue after valve placement. Air can flow to the diseased lung tissue if a fissure is incomplete. Patients with incomplete fissures are better candidates for LVRS.
Patient Criteria for Lung Volume Reduction Surgery
We follow guidelines from the National Emphysema Treatment Trial (NETT) to decide who should get LVRS. Your thoracic surgeon looks at specific characteristics:
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Diffusion capacity (DLCO)— DLCO measures how well your lungs transfer carbon dioxide and oxygen between your blood and the air. Higher DLCO percentages mean your lungs exchange carbon dioxide and oxygen better. You must have a DLCO of at least 20% to qualify for LVRS.
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Forced expiratory volume (FEV1)— Your FEV1 refers to how much air you push out in one second. Ìð¹ÏÊÓƵy ranges for FEV1 vary. Generally, higher percentages mean your diagnosis is less severe. Candidates for LVRS must have an FEV1 between 20–45%.
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Location of diseased tissue—You must have some healthy lung tissue for LVRS to work. People who have damaged tissue in the top part of their lungs (upper lobe) also tend to be better candidates for LVRS.
What to Expect Before Lung Volume Reduction Surgery
You need several tests before lung volume reduction surgery. Sometimes you have these tests with your pulmonologist. Or you may get them during evaluation for a lung transplant. In other cases, your thoracic surgeon orders your tests. Your tests do different things:
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Cardiac testing, such as an echocardiogram, to check whether lung disease affects your heart
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CT scans to get a clear picture of your lungs
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Pulmonary function tests to measure DLCO and FEV1
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Ventilation perfusion scan to check air and blood flow to your lungs
You complete about three months of pulmonary rehabilitation before surgery. Pulmonary rehabilitation helps strengthen your lungs. It increases your ability to handle surgery and decreases the chances of complications.
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What to Expect During Lung Volume Reduction Surgery
You receive general anesthesia to remain asleep during surgery. Your thoracic surgeon operates using several steps:
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Makes three half-inch incisions on the side of your chest near your ribs
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Inserts a thin tool with a camera (thoracoscope) through the incisions
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Uses your CT scan to check where your damaged tissue is
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Removes the diseased tissue
Most people with severe emphysema have diseased tissue in both lungs. Sometimes your thoracic surgeon operates on both sides of your chest in one procedure. Other times, they operate on one side first, then treat the other several months later. It depends on how severe the disease is. Surgery usually lasts around one hour per side.
What to Expect After Lung Volume Reduction Surgery
You stay in the intensive care unit (ICU) for one night after surgery. You have a drainage tube in the side of your chest. The tube remains in place for at least one night. It’s possible to develop an air leak in the chest tube, which delays removal.
How long you stay in the hospital depends on when we remove your drainage tube and how you feel after the operation. Most people spend around 2–4 nights in the hospital.
Lung Volume Reduction Surgery Recovery
You will have some chest pain and soreness for about two weeks. You’ll need to take it easy and avoid working. Most people have a gradual improvement in their symptoms. You may go to pulmonary rehabilitation to strengthen your lungs during recovery.
Does Lung Volume Reduction Surgery Leave a Scar?
We almost always perform LVRS with minimally invasive techniques. Minimally invasive techniques leave tiny scars. These scars don’t affect your breathing.
Risks of Lung Volume Reduction Surgery
Your surgeon will discuss the risks of LVRS with you. Some people still need to use a ventilator after surgery. However, research shows this risk lowers when doctors follow the NETT guidelines to decide whether you can get the treatment.
Lung Volume Reduction Surgery Success Rate
NETT data shows that LVRS improves quality of life in patients who are good candidates for it. The procedure can help you reduce external oxygen use, be more active, and feel better.
Why Choose Ìð¹ÏÊÓƵ of Utah Ìð¹ÏÊÓƵ?
Ìð¹ÏÊÓƵ of Utah Ìð¹ÏÊÓƵ offers comprehensive, leading-edge treatment for end-stage lung disease. Our specialists in pulmonary services, cardiothoracic surgery, and lung transplants work together to bring you a full range of therapies. We offer every treatment option from endobronchial valve placement through lung transplant.
Our team includes pulmonologists specializing in end-stage lung disease. Many of our doctors are researchers who are well-known nationally for their expertise.
