Lung volume reduction surgery is the solution to emphysema, which is one of the most serious forms of chronic obstructive pulmonary disease (COPD) and directly affects a person’s ability to breathe and perform the simplest activities of life.
Studies have shown that approximately 50% to 75% of patients reported an improvement in symptoms after surgery, and this improvement was more pronounced in patients with upper lobar bloat, with a 10% increase in five-year survival rates and in patients with low-performing bilateral disease.
What is lung volume reduction surgery, and why is it performed?
Lung volume reduction surgery (LVRS) is a surgical procedure in which parts of the lungs are removed to help them function more efficiently by removing the damaged parts of the lungs that trap air. LVRS reduces the size of the lungs, decreases the amount of pressure on the diaphragm, and increases lung elasticity, allowing air to reach the bloodstream and tissues.
Doctors recommend this surgery to relieve symptoms in some people with severe emphysema, a type of chronic obstructive pulmonary disease (COPD) that can cause air to become trapped in pockets within the lungs.
When does a patient need this lung volume reduction surgery?
LVRS primarily targets patients with severe emphysema, a subtype of chronic obstructive pulmonary disease (COPD). COPD is a leading cause of death worldwide, and patients with severe emphysema can have a poor quality of life with symptoms that affect functioning.
The anatomy related to lung volume reduction surgery involves the upper lobes of the lungs, which are more often affected by emphysematous changes than the lower lobes. Surgery usually involves removing approximately 20% to 30% of the most diseased lung tissue, usually from the upper lobes. Removing hyperinflated and non-functional lung tissue allows the remaining healthy lung tissue to expand more effectively, which reduces lung volume and helps the diaphragm reach an optimal position, improving its ability to contract and enhancing ventilation efficiency.
Cases where surgery is not recommended
Lung volume reduction surgery cannot be performed if the patient has other long-term conditions with emphysema, such as pulmonary fibrosis, severe pulmonary hypertension, or heart failure. Emphysema spreads evenly across the lungs, making it difficult to find the right parts of the lungs to target. If you are severely underweight or if the damage to the lungs is too severe, lung volume reduction surgery may not be an option.
Types of lung volume reduction surgery
Types of lung volume reduction surgery vary based on the methods used to remove damaged tissue from the lung, and include the following:
- Open Thoracotomy LVRS: The rib cage is opened to access the lungs, allowing the surgeon to visualize the lungs and remove tissue fully, but it requires a long recovery period and complications such as pain and infection.
- VATS (video-assisted thoracoscopic surgery): A less invasive procedure that uses small instruments and a camera inserted through small incisions in the chest, offering little postoperative pain and a quick recovery, but can be less precise than open surgery.
- Non-surgical methods such as Endobronchial Valves: An alternative option for patients who do not qualify for traditional surgery, this minimally invasive procedure uses small devices implanted into the airway (bronchus) using a bronchoscope, reducing shortness of breath and does not require an incision or general anesthesia.
Comparison: Lung reduction surgery vs Lung transplant
It is essential to understand the differences between lung reduction surgery and lung transplantation to determine who is eligible for beneficial treatment. The most important of these comparisons are:
| Element | Lung volume reduction | Lung transplantation |
| Suitable category | Patients with localized damage | Patients with complete pulmonary failure |
| Availability of treatment | common | Limited due to a lack of donors |
| Complications | A few | Many and complex |
| Long-term results | Moderate to good improvement | Significant improvement, but with constant monitoring |
How is lung volume reduction surgery performed?
Before surgery, the doctor asks the patient to refrain from eating and from taking certain medications. Just before the operation begins, the surgeon asks the patient to lie on his back or side and is given general anesthesia to make him sleep throughout the surgery, and incisions will be made in the middle of the chest or between the ribs and use surgical pins to remove parts of the lung and separate the damaged part from the upper part of the lung and close the edges well from the healthy part of the lung.
Tubes are placed to drain fluid between the lungs, incisions are closed and covered, and antibiotics may be used. The procedure results in improved quality of life, reduced shortness of breath and pressure on the diaphragm, and increased exercise capacity.
Post-surgery and recovery
The length of hospitalization after surgery varies from person to person but usually ranges from four to ten days, and recovery from laparoscopic surgery usually takes less time compared to other types of surgery that require larger incisions.
Emphasis should be placed on physical respiratory therapy, which is usually started in the hospital and continued after discharge, and includes breathing exercises, diaphragm optimization, and effective coughing techniques. Improvement in pulmonary function takes between 1 and 3 months, while monitoring for possible air leaks from the lungs, infections, or heart attacks, and minimizing reliance on home oxygen.
When does a patient’s quality of life improve after surgery?
Some studies have reported improvement in aspects of quality of life after LVRS for up to 3 months (significant improvement in measures of physical functioning, social functioning, general health and vitality), and for 6 months (significant improvement in physical functioning, physical role limitations, general health), significant change in the Physical Component Summary Scale and reduced need for medication and psychological assistance, in specific cases (upper lobe bloat with reduced muscle capacity), while other cases may increase mortality or cause other complications.
In conclusion, lung volume reduction surgery (LVRS) is an advanced, precision-targeted treatment option for patients with severe emphysema when conventional treatments become insufficient to improve quality of life, with benefits such as reduced shortness of breath, increased mobility, and improved diaphragm function. If you or a loved one is suffering from advanced symptoms of COPD, do not hesitate to consult a doctor who specializes in chest diseases or thoracic surgery to assess the suitability of this type of surgery.
Sources:
- Lee, M., Sharma, S., & Mora Carpio, A. L. (2024, August 11). Lung Volume Reduction Surgery. In StatPearls. StatPearls Publishing
- The Ohio State University Wexner Medical Center. (n.d.). Lung Volume Reduction Surgery (LVRS)
