Lung volume reduction surgery (LVRS) involves the removal of damaged lung tissue, which can help people with lung damage breathe more easily.
Doctors tend to recommend LVRS to people with severe chronic obstructive pulmonary disease (COPD), but it is not suitable for everyone with this condition.
In this article, we explain the goal of LVRS, who can undergo this type of surgery, its potential benefits and risks, and the recovery times.
The goal of LVRS is to remove damaged areas of lung tissue, particularly unhealthy air sacs, so the remaining tissue can work more effectively. The surgery can improve breathing and quality of life for people with COPD.
Doctors tend to refer people for surgery when they:
Before a person can have LVRS, a pulmonologist and thoracic surgeon will run several tests, including:
- pulmonary function test
- 6-minute walk test
- CT scan of the lungs
- electrocardiography (EKG)
- arterial blood gas test
- cardiopulmonary exercise test
Once the evaluation is complete, a medical professional will administer a general anesthetic, which makes someone unconscious and stops them from feeling any pain.
Surgeons can approach LVRS in several ways. They may perform:
- Media sternotomy: This procedure involves a surgeon making an incision through the sternum, which is the bone that runs down the center of the ribs.
- Video-assisted thoracoscopy: A surgeon will make small incisions in one or both sides of the chest. They will then insert a scope, or a small camera. The camera sends images of the lungs to a computer screen, which allows surgeons to identify and remove damaged tissue using instruments on “chopsticks.”
- Thoracotomy: During this more invasive form of LVRS, a surgeon makes an incision on the side of the chest, in between the ribs. They then separate the ribs to gain access to the lungs.
After surgery, a person can expect to stay in the hospital for 10–14 days. The exact length of stay will vary depending on how a person responds to the surgery and whether they have any underlying health conditions. The healthcare team will provide the person with access to pain medication through an IV drip or in the form of tablets.
When a person leaves the hospital, they may find that their appetite is not as large as it used to be, so they should try eating smaller portion sizes that are easier to digest. If anyone notices that their appetite is not improving, they should get in touch with their doctor.
The incisions may feel bumpy while they are healing, but they should smooth over within 6–8 weeks. A person should wait until their incisions have healed before applying creams and lotions to them.
It is important to avoid lifting anything heavy for 6–8 weeks and to refrain from driving if pain medication causes tiredness.
Some people will be able to go back to work within 4–6 weeks, but those with more strenuous jobs will likely have to wait 8–12 weeks. A person should check with a doctor that it is safe to return to work before making a commitment.
The main benefit of LVRS is an improvement in lung function. After LVRS, people may notice that they can exercise for longer, as their lungs are exchanging oxygen and carbon dioxide more efficiently. Quality of life should also improve, as people can complete day-to-day tasks without getting out of breath.
However, as with all types of surgery, there are some risks. These include:
Less commonly, people can experience an irregular heartbeat or a heart attack. The risk of complications increases if a person has other underlying health conditions. About 4 in 100 people who undergo LVRS die from complications that occur during the procedure.
It is important to weigh up the benefits and risks of LVRS thoroughly with a doctor. In some cases, another type of procedure may be more suitable.
People with severe COPD and emphysema have several options for treatment. These include:
- Bullectomy: When a person has lung tissue damage, their air sacs can enlarge and press on healthy parts of the lungs, which stops them from working as efficiently. A bullectomy removes these large air sacs to help a person breathe better. However, few people with emphysema have large enough air sacs for this procedure to work.
- Lung transplantation: During transplantation, a surgeon replaces a person’s lung with one from an organ donor. Doctors tend to reserve this procedure for people with COPD who do not have any other underlying health conditions.
- Endobronchial valve reduction: If a person constantly feels breathless, a surgeon can place valves in the lung that collapse the areas that no longer work. This procedure is new and may not be available at all hospitals.
COPD healthcare can be expensive in the United States. However, people who can access health insurance do not need to pay for LVRS or other procedures for COPD.
Under the Affordable Care Act, insurance providers cannot deny coverage to people with COPD as a preexisting condition. They also cannot charge people with COPD more for coverage or limit the total healthcare costs of these individuals over their lifetime.
As a result, affordable LVRS should be accessible for many in the U.S. However, surgery still has associated expenses. For example, a person may need to take extended time off work. It is a good idea to factor in any finance-related issues ahead of time when planning to undergo LVRS.
LVRS involves a surgeon removing areas of lung tissue that have become damaged as a result of COPD. A doctor may refer someone for LVRS if they have severe emphysema and struggle to exercise. However, not everyone is eligible for the procedure.
A surgeon can perform LVRS using different surgical techniques, with some being less invasive than others. After surgery, people typically stay in the hospital for 10–14 days before going home. Recovery times vary, but many find that they can go back to work in 4–6 weeks, depending on the type of work that they do.
Other types of surgery that may help include a bullectomy, lung transplantation, and endobronchial valve reduction. A doctor who specializes in respiratory health, called a pulmonologist, can talk someone through their options and explain what each one involves.