What is Lung Volume Reduction Surgery?
Lung volume reduction surgery (LVRS) is a surgical option to treat emphysema, and is only performed when the use of all medical treatments (medications, pulmonary rehabilitation) have been tried and symptoms still persist. During the surgery, 20% to 30% of the most diseased portions of the lung are removed. By reducing the size of the over-expanded lung, the diaphragm, chest wall, and rib cage are able to resume to a more normal shape and to work more efficiently.
Are All Patients With Emphysema Candidates for Lung Volume Reduction Surgery?
No. Your physician will review certain criteria before recommending surgery:
- The severity of your disease must be documented by complete lung function testing, chest x-rays and CT (computerized tomography) films.
- You will be required to quit smoking at least six months before surgery.
- If you have a history of heart surgery or previous lung surgery you may not be eligible for the surgery.
- You should have no other major disease (i.e. heart failure, cancer, recent stroke, severe osteoporosis, kyphosis or curvature of the spine, kidney failure, severe pulmonary hypertension) or other lung disease such as severe asthma, pulmonary fibrosis, or bronchiectasis.
- Chronic prednisone dosage should not be more than 20mg daily.
- You must be willing to be involved in an intensive pre- and postoperative pulmonary rehabilitation program.
- You must be in an acceptable weight range. This means a BMI ≤31.1 (males) and a BMI ≤32.3 (females).
What Happens During the Lung Volume Reduction Surgery?
- General anesthesia is given.
- The lung is exposed (one side at a time).
- The most diseased areas of the lung are removed, using surgical staplers to seal the remaining lung.
- Four chest tubes are placed in each chest cavity to allow drainage and help re-expand the lungs. It is common to have 4 tubes placed during surgery.
- The chest is closed.
- The patient is monitored in the Intensive Care Unit overnight.
- The total time of the operation is 3-4 hours.
How Does the Lung Volume Reduction Surgery Improve Shortness of Breath?
The most diseased lung tissue is removed, allowing the least diseased tissue to maximize its breathing capacity. This enables the muscles used in breathing to regain their function. The rib cage and diaphragm are able to return to their normal shape because the lungs are reduced in size and better able to contract and expand while breathing.
What are the Risks of Surgery?
Anesthesia is always a risk for COPD patients undergoing lung volume reduction surgery. Each surgical outcome varies. Because of poor tissue healing and risk for tearing of the thinned-out emphysematous lungs, there is a significant risk for persistent air leaks from the resected lung requiring prolonged chest tube drainage and possibly discharge with the chest tubes in place. As with any patient that has emphysema, pneumonia can be a severe complication, sometimes leading to death. Your physician will discuss the other associated risks from the anesthesia and the surgical procedure itself.
When Will my Breathing Improve, and Will I be Able to Stop Using Oxygen?
Improvement in breathing is generally noticed within six to eight weeks following the operation. This improvement is ongoing as you continue your exercise program. Exercise is very important in helping to regain your physical strength and retraining your chest wall muscles to work. It is important to understand that not all patients have improved breathing after the surgery.
The goal of the surgery is not to eliminate the need for supplemental oxygen. In fact, it is very unlikely that lung volume reduction surgery will allow a patient to remain off supplemental oxygen post-operatively.
How Long is the Exercise Program?
The exercise program before surgery consists of at least 16 sessions, each at least 2 hours, completed over a 6-10 week time frame.
After surgery you need to complete at least six exercise sessions, each at least 2 hours within 8-9 weeks from your surgical date.
What is the Process for Becoming a Candidate for Lung Volume Reduction Surgery?
All patients considering lung volume reduction must have the following screening
- Complete medical history and physical exam
- Complete pulmonary function tests
- Arterial blood gas
- Cardiopulmonary exercise test (CPET)
- Inspiratory and expiratory chest x-rays
- Chest CT scan
- Evaluation by a pulmonologist
If after the above screening exams are completed and the patient is a likely candidate for lung volume reduction surgery, the following must be completed prior to an appointment with a thoracic surgeon:
- Ventilation/perfusion scan (V/Q scan)
- Electrocardiogram (EKG)
- Ultrasound of the heart (echocardiogram)
- Cardiac stress test (dobutamine thallium)
- Six-minute hallwalk
- Labs (plasma cotinine level)
- Cardiopulmonary exercise test (CPET)
- Pulmonary rehabilitation (at least 16 sessions)
Will my Insurance Cover the Procedure?
As of January 1, 2004 Medicare covers lung volume reduction surgery at selected sites across the United States. If you do not have Medicare insurance, written approval from your insurance company stating they will pay for surgery will be required before an appointment with a thoracic surgeon can be made.
To learn more about whether you are a candidate for lung volume reduction surgery, contact us at 734-763-7668 or toll free: 1-888-284-5864 (1-888-284-LUNG).
View or Download a PDF about Emphysema and Lung Volume Surgery at the University of Michigan.