Lung volume reduction surgery is a surgical procedure aimed at improving the breathing and quality of life for people with severe emphysema.
Emphysema is a type of chronic obstructive pulmonary disease (COPD).
Lung volume reduction surgery involves removing diseased, non-functional lung tissue to enhance the function of the remaining healthier lung tissue.
Learn more about lung volume reduction surgery, including its definition, indications, candidate criteria, the surgical process, post-operative care, and potential risks and complications.
Thoracic surgeons at WashU Medicine
Lung surgeons at WashU Medicine see patients at Barnes-Jewish Hospital, one of the top hospitals in the nation for lung disease care, as well as convenient locations across the region.
What is lung volume reduction surgery?
Lung volume reduction surgery involves the removal of damaged, emphysematous lung tissue, typically from the upper lobes.
By reducing the lung volume, the remaining healthier lung tissue can function more effectively, allowing the diaphragm to work more efficiently and improving overall respiratory mechanics.
Benefits of lung volume reduction
Lung volume reduction surgery has been shown to:
- Relieve shortness of breath
- Increase energy level and physical mobility
- Improve ability to function at work and do housework
- Make social life and hobbies more enjoyable
- Create a dramatic improvement in lung function
Who might need lung volume reduction surgery?
Lung volume reduction surgery may be an indication for people with severe emphysema whose symptoms significantly impact their life.
Learn more about emphysema>>
Severe emphysema
- Upper-lobe predominant emphysema: Lung volume reduction surgery is most effective for patients with severe emphysema affecting the upper lobes of the lungs.
- Chronic obstructive pulmonary disease (COPD): Patients with advanced COPD and significant hyperinflation (excessive lung inflation) may benefit from lung volume reduction surgery.
Symptom relief
- Breathlessness: Lung volume reduction surgery may help people experiencing severe shortness of breath that limits daily activities despite maximum medical therapy.
- Exercise intolerance: Difficulty with physical activities due to breathing limitations.
Candidate criteria for lung volume reduction surgery
Potential candidates undergo extensive screening and diagnostic tests, including pulmonary function tests, high-resolution CT scans, and a comprehensive evaluation of overall health. These assessments determine the severity of lung damage and the patient’s suitability for surgery.
Clinical assessment
- Severity of disease: Candidates typically have severe emphysema with a forced expiratory volume in one second (FEV1) between 20% and 45% of the predicted value and a total lung capacity (TLC) and residual volume (RV) significantly above normal.
- Impact on quality of life: Symptoms significantly impact the patient’s quality of life and daily functioning.
Health evaluation
- Overall health: Candidates should be in suitable general health to withstand surgery and postoperative recovery. Adequate cardiac function and the absence of other severe health conditions are important considerations.
- Smoking cessation: Patients must have stopped smoking for at least six months before the surgery.
Preoperative evaluations
- Pulmonary rehabilitation: Completion of a pulmonary rehabilitation program to optimize the patient’s physical condition and breathing techniques.
- Imaging studies: High-resolution computed tomography (CT) scans to assess the extent and location of emphysema.
- Pulmonary function tests: Comprehensive lung function tests to measure the patient’s breathing capacity and lung mechanics.
The lung volume reduction surgery process
Preoperative preparation
- Consultation: Detailed discussion with a thoracic surgeon and pulmonologist about the procedure, benefits, risks, and alternatives.
- Medical optimization: Managing and optimizing any comorbid conditions such as hypertension, diabetes, and heart disease.
- Pre-surgical testing: Blood tests, electrocardiogram (ECG), chest X-ray, and other necessary evaluations to ensure the patient’s readiness for surgery.
Surgical steps
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free during the procedure.
- Incision and access: The surgeon makes an incision in the chest, which can be done either through a median sternotomy (splitting the breastbone) or thoracotomy (a side incision) to access the lungs.
- Resection of diseased lung tissue: The surgeon identifies and removes the most damaged sections of the lung, typically around 20-35% of each lung. The remaining lung tissue is reshaped and stapled.
- Closure: The incisions are closed, and chest tubes are placed to help drain fluids and re-expand the lungs post-surgery.
Duration
- Timeframe: The procedure typically takes between 2 to 4 hours.
Post-operative care and recovery
Immediate postoperative care
- Intensive care unit (ICU): Patients are usually monitored in the ICU for the first 24-48 hours after surgery to ensure stability and manage pain.
- Pain management: Administration of pain relief medications to ensure comfort and facilitate recovery.
Hospital stay
- Duration: The average hospital stay is about 1 to 2 weeks, depending on recovery progress and any complications.
Respiratory support
- Supplemental oxygen: Most patients will require supplemental oxygen initially, with the goal of weaning off as the lungs recover.
- Incentive spirometry: Regular use of an incentive spirometer to promote lung expansion and prevent complications such as pneumonia.
Rehabilitation and follow-up
- Pulmonary rehabilitation: Continuation of pulmonary rehabilitation exercises post-surgery to enhance lung function and overall physical fitness.
- Follow-up visits: Regular check-ups with the surgical and pulmonary teams to monitor progress, manage medications, and address any complications.
Potential risks and complications
- Pain and discomfort: Pain at the incision site and general discomfort, which can be managed with pain medications.
- Infection: Risk of infection at the surgical site or within the lungs.
- Pneumothorax: Collapse of the lung, which may require additional interventions or chest tube management.
- Prolonged air leaks: Persistent air leaks from the lung tissue that may prolong hospitalization.
- Respiratory failure: In rare cases, patients may experience significant respiratory distress or failure requiring mechanical ventilation.
Long-term considerations
- Quality of life improvements: Many patients experience significant improvements in breathing, exercise capacity, and overall quality of life.
- Lifestyle modifications: Patients are encouraged to maintain a healthy lifestyle, including avoiding smoking and adhering to prescribed pulmonary rehabilitation exercises.
Lung volume reduction surgery is a viable option for individuals with severe, upper-lobe predominant emphysema who have not achieved sufficient relief from medical therapy.
Understanding the indications, candidate criteria, surgical process, post-operative care, and potential risks is crucial for making an informed decision.
Consult with a specialized medical team to discuss your specific condition and determine the best approach for your care.
