Lung volume reduction surgery

Lung volume reduction surgery is used to help some people with severe emphysema, a type of chronic obstructive pulmonary disease (COPD), breathe easier. It's very important for a multispecialty team of experts to identify and look at people who may benefit from this surgery. Some people may not be good candidates for this procedure.

Using minimally invasive techniques whenever possible, a surgeon removes areas of diseased lung tissue that are not being used by the body. Then the remaining lung tissue can work better. After surgery, people often have less shortness of breath and better quality of life. They also are better able to exercise. Importantly, this therapy may help some people live longer.

During lung volume reduction surgery, a chest surgeon — also known as a thoracic surgeon — removes about 20% to 35% of the diseased lung tissue to allow the rest of the tissue to work better. As a result, the diaphragm — the muscle that separates your chest from your stomach area — tightens and relaxes more effectively and efficiently. This lets you breathe easier.

To determine whether you might benefit from lung volume reduction surgery, your doctor may recommend:

• Imaging and evaluation, including tests of your heart and lung function, exercise tests, and a CT scan of your lungs, to find out where the emphysema is and how bad it is.
• Pulmonary rehabilitation, a program that helps people take care of themselves by improving how well they do physically and emotionally.

Risks of lung volume reduction surgery include:

• Getting pneumonia.
• Forming a blood clot.
• Needing to be on a breathing machine for more than two days.
• Having a lasting air leak. With an air leak, a chest tube drains air from your body. Most air leaks heal within a week.

Risks that are less likely include wound infection, irregular heart rhythm, heart attack and death. For those who had no problem exercising and their emphysema was not in the upper lobes of the lung, lung volume reduction surgery didn't improve function, and survival times were lower.

If damage to your lungs is too severe, lung volume reduction surgery may not be an option. Other treatments such as endobronchial valve therapy may be an option. Endobronchial valves are removable one-way valves that let trapped air escape from the diseased part of the lung. This reduces the size of the diseased lobe. As a result, the air that you breathe is spread to other parts of the lung that are working better. This helps you breathe better and decreases shortness of breath. For cases where lungs are damaged beyond repair, a lung transplant may be considered.

Before lung volume reduction surgery, your heart and lungs may be tested to see how well they work. You also may take part in exercise tests and have an imaging test of your lungs. You may take part in pulmonary rehabilitation, a program that helps people improve how well they function physically and emotionally.

Before lung volume reduction surgery, you may be seen by a doctor who specializes in the lungs — also called a pulmonologist — and a doctor who specializes in chest surgery, called a thoracic surgeon. You may need to get CTs of your lungs and an ECG to record the electrical signals in the heart. You also may have a series of tests to learn more about your heart and lungs.

During lung volume reduction surgery, you'll be completely asleep and on a breathing machine. Most surgeries can be done in a less invasive way. Your surgeon will make several small cuts, called incisions, on both sides of your chest to get to your lung. In some cases, instead of several small cuts, the surgeon may make one deeper incision in the middle of your chest or between the ribs on the right side of your chest.

The surgeon will remove 20% to 35% of the most diseased lung tissue. This surgery may allow the diaphragm to return to its natural shape, which would help you breathe easier.

Studies have shown that those who had lung volume reduction surgery fared better than those who didn't have surgery. They were able to exercise more. And their lung function and quality of life were sometimes better.

People who are born with an inherited form of emphysema, called alpha-1-antitrypsin deficiency-related emphysema, aren't likely to benefit from lung volume reduction surgery. A lung transplant may be a better treatment option than lung volume reduction surgery for them. For the best care, patients with this condition should be referred to a team of healthcare professionals representing multiple specialties.