What is Lung Volume Reduction Surgery? Purpose, Procedure & Results

Lung volume reduction surgery (LVRS) is a procedure that removes damaged portions of your lungs to help the remaining healthy tissue work more efficiently. Think of it as making room for your good lung tissue to expand and function better by removing the parts that aren't helping you breathe.

This surgery is primarily designed for people with severe emphysema, a condition where air sacs in your lungs become damaged and trap air. When surgeons remove these damaged areas, your diaphragm can move more freely, and your remaining lung tissue can do its job more effectively.

What is lung volume reduction surgery?

Lung volume reduction surgery involves removing 20-30% of your most damaged lung tissue from both lungs. The goal is to improve your breathing capacity and quality of life by allowing your healthier lung tissue to expand properly.

During the procedure, surgeons identify the areas of your lungs that are most severely damaged by emphysema. These sections often appear like deflated balloons that can't properly exchange oxygen and carbon dioxide. By removing these non-functional areas, the surgery helps your chest muscles and diaphragm work more efficiently.

The procedure can be performed using different techniques, including traditional open surgery or minimally invasive approaches. Your surgeon will choose the best method based on your specific lung condition and overall health status.

Why is lung volume reduction surgery done?

This surgery is recommended for people with severe emphysema who continue to struggle with breathing despite optimal medical treatment. The primary goal is to improve your quality of life and breathing capacity when other treatments haven't provided enough relief.

You might be a candidate for LVRS if you have upper lobe emphysema, where the damage is concentrated in the upper parts of your lungs. This type of damage pattern tends to respond better to surgical intervention than other forms of emphysema.

The surgery can help reduce your shortness of breath, increase your exercise tolerance, and potentially extend your life expectancy. Many patients find they can return to activities they previously couldn't manage, like walking longer distances or climbing stairs.

What is the procedure for lung volume reduction surgery?

The surgery typically takes 3-4 hours and is performed under general anesthesia. Your surgical team will use one of several approaches depending on your specific condition and the surgeon's preference.

Here's what generally happens during the procedure:

1. You'll receive general anesthesia to keep you comfortable and unconscious
2. The surgeon makes incisions to access your lungs (either through small keyhole incisions or a larger chest incision)
3. Using specialized tools, they identify the most damaged lung tissue
4. The damaged portions are carefully removed using stapling devices
5. The remaining healthy lung tissue is checked for air leaks
6. Chest tubes are placed to help drain fluid and air
7. The incisions are closed with sutures or staples

The specific technique used may vary. Some surgeons use video-assisted thoracoscopic surgery (VATS), which uses smaller incisions and a tiny camera. Others may use a median sternotomy, which involves opening the chest through the breastbone.

How to prepare for your lung volume reduction surgery?

Preparation for LVRS involves several weeks of evaluation and conditioning to ensure you're as healthy as possible for surgery. Your medical team will work closely with you to optimize your condition before the procedure.

Your preparation will likely include these important steps:

1. Pulmonary rehabilitation program to strengthen your breathing muscles
2. Comprehensive lung function tests and imaging studies
3. Cardiac evaluation to ensure your heart can handle the surgery
4. Nutritional assessment and optimization of your weight
5. Complete blood work and other medical tests
6. Smoking cessation if you still smoke (absolutely essential)
7. Medication adjustments as recommended by your doctor

You'll also need to stop certain medications before surgery and arrange for help at home during your recovery. Most patients spend 6-8 weeks in pulmonary rehabilitation before surgery to build up their strength and breathing capacity.

How to read your lung volume reduction surgery results?

Success after LVRS is measured by improvements in your breathing capacity, exercise tolerance, and overall quality of life rather than just numbers on a test. Your doctors will track several key indicators to assess how well the surgery worked for you.

Here are the main ways your medical team will evaluate your results:

• Forced expiratory volume (FEV1) - measures how much air you can blow out in one second
• Six-minute walk test - tracks how far you can walk in six minutes
• Quality of life questionnaires about daily activities
• Oxygen saturation levels during rest and activity
• Chest X-rays and CT scans to see lung expansion
• Arterial blood gas tests to check oxygen and carbon dioxide levels

Most patients see improvements within 3-6 months after surgery. You might notice you can walk further without getting winded, climb stairs more easily, or participate in activities you couldn't do before the surgery.

What is the best outcome for lung volume reduction surgery?

The best outcomes occur in patients with upper lobe emphysema and low exercise capacity before surgery. These individuals often experience the most significant improvements in breathing, exercise tolerance, and quality of life.

Ideal candidates typically see a 15-20% improvement in their lung function tests and can walk 50-100 feet further in the six-minute walk test. Many patients also report feeling less short of breath during daily activities like bathing, cooking, or light housework.

The benefits can last several years, though emphysema is a progressive condition. Some patients maintain their improved function for 5-10 years or more, while others may see gradual decline over time as the remaining lung tissue ages.

What are the risk factors for poor lung volume reduction surgery outcomes?

Certain factors can increase your risk of complications or poor outcomes from LVRS. Understanding these risk factors helps your medical team determine if you're a good candidate for the procedure.

Several conditions can make the surgery more risky for you:

• Very low lung function (FEV1 less than 20% of normal)
• Severe heart disease or pulmonary hypertension
• Continued smoking or recent smoking history
• Severe malnutrition or being significantly underweight
• Previous chest surgery or severe chest scarring
• Active infections or recent respiratory illness
• Advanced age (over 75-80 years old)
• Homogeneous emphysema (damage spread evenly throughout lungs)

Your medical team will carefully evaluate these factors during your pre-surgical assessment. Sometimes, addressing certain risk factors like nutrition or conditioning can improve your candidacy for the procedure.

Is it better to have lung volume reduction surgery or medical management?

The decision between surgery and continued medical management depends on your specific type of emphysema, current symptoms, and overall health status. For the right candidates, LVRS can provide significant benefits that medical treatment alone cannot achieve.

Surgery tends to be more beneficial if you have upper lobe emphysema with areas of severe damage mixed with healthier tissue. In these cases, removing the worst areas can dramatically improve how your remaining lung tissue functions.

Medical management might be better if you have homogeneous emphysema (damage spread evenly throughout your lungs) or if your exercise capacity is still relatively good. Your pulmonologist will help you weigh the potential benefits against the surgical risks based on your individual situation.

What are the possible complications of lung volume reduction surgery?

Like any major surgery, LVRS carries both common and rare risks that your medical team will discuss with you in detail. Understanding these potential complications helps you make an informed decision about whether the surgery is right for you.

Here are the more common complications you should be aware of:

• Prolonged air leaks from the lung surface (occurs in 30-50% of patients)
• Pneumonia or other respiratory infections
• Bleeding requiring blood transfusion
• Irregular heart rhythms during recovery
• Temporary confusion or delirium after anesthesia
• Wound healing problems or infection at incision sites
• Blood clots in legs or lungs

More serious but less common complications can include respiratory failure requiring prolonged mechanical ventilation, heart attack, stroke, or in rare cases, death. The overall mortality rate for LVRS is approximately 2-5% depending on the medical center and patient selection.

When should I see a doctor after lung volume reduction surgery?

You should contact your medical team immediately if you experience any concerning symptoms during your recovery. Early recognition and treatment of complications can prevent more serious problems from developing.

Call your doctor right away if you notice any of these warning signs:

• Sudden worsening of shortness of breath or chest pain
• Fever over 100.4°F (38°C) or signs of infection
• Coughing up blood or yellow-green sputum
• Redness, swelling, or drainage from your incisions
• Chest tube drainage that suddenly increases or changes color
• Severe pain that isn't controlled by your prescribed medications
• Swelling in your legs or difficulty breathing when lying flat

You'll have regular follow-up appointments to monitor your healing and track your improvement. These visits are crucial for catching any problems early and adjusting your recovery plan as needed.