Lung volume reduction surgery (LVRS) is a procedure performed to remove abnormal lung tissue in patients with significant shortness of breath due to chronic obstructive pulmonary disease (COPD). The diseased lung does not allow for normal air movement, resulting in air trapping and over-inflation of the lung. Removal of the diseased tissue allows for the more normal lung tissue to expand and improve air exchange.
For select patients, LVRS has been demonstrated to improve breathing ability, exercise capacity, and quality of life. Results depend on the location of the disease area within the lung as well as the patient’s exercise capability and ability to tolerate surgery. Several tests are necessary to determine if a patient would benefit from this procedure, including:
Pre-operative evaluation by a multidisciplinary team including a pulmonologist, respiratory therapist and thoracic surgeon is necessary to determine candidacy. The multidisciplinary team at Baylor University Medical Center in Dallas has extensive experience evaluating patients for LVRS. Cessation of smoking is mandatory and all patients must complete an extensive pulmonary rehabilitation program prior to surgery.
LVRS must be performed by a thoracic surgeon with extensive experience performing this procedure in order to assure optimal outcomes. All surgeons in Baylor Scott & White Center for Thoracic Surgery have extensive experience performing this procedure.
LVRS is typically performed in on both lungs at the same time using video-assisted thoracoscopic surgery (VATS). VATS is a minimally-invasive technique that is performed through 2-3 small incisions between the ribs and utilizes a high-definition video camera to work inside the chest without making a large incision, dividing the breastbone or spreading the ribs. This results in decreased pain after surgery and a quicker recovery. An epidural catheter is often placed by the anesthesiologist to further decrease post-operative pain.
The camera is inserted through one incision and a specialized stapler is inserted through another incision to remove the disease lung. The procedure is then repeated on the opposite lung. One or two drainage tubes are left in each side of the chest to remove fluid and air which typically accumulate after lung surgery; once drainage of fluid and air has ceased, the tubes are removed and the patient is discharged home, which is typically 7-10 days after surgery.
Complications of LVRS include bleeding, infection including pneumonia, persistent leakage of air from the lung tissue, and death. For appropriately selected patients, these risks are low and outcomes are excellent, with improved exercise capacity and increased long-term survival. Alternatives to LVRS include no surgery, continued medical management and pulmonary rehabilitation. Additionally, clinical trials are currently underway testing valves that are placed on the inside of the airway, preventing air from entering the diseased portion of the lung and possibly achieving the same goal as LVRS.