Lung Volume Reduction Surgery

Lung volume reduction surgery (LVRS) is a treatment option for some people with severe chronic obstructive pulmonary disease (COPD). It is recommended for people with emphysema where the lung damage is mainly in the upper part of the lungs. It is not recommended for severe COPD when the person has many other health problems (comorbidities).1

Emphysema is one of the 2 conditions that make up COPD. The other is chronic bronchitis. People with emphysema have damage to the millions of tiny air sacs in the lungs called alveoli. The alveoli are where the body absorbs oxygen. For people with emphysema, the damage can prevent their bodies from absorbing enough oxygen.2

Doctors do not fully understand why LVRS improves symptoms. One idea is that during LVRS, small pieces of the damaged lungs are removed. This allows the remaining lung tissue to work better. It also makes it easier for your diaphragm, the main muscle that controls breathing, to work better. This can make breathing easier and reduce COPD symptoms.1-3

How does LVRS help treat COPD?

Removing the damaged portions of the lungs allows the remaining healthy parts to function better. This can make breathing easier and more efficient, which improves quality of life. LVRS is the only treatment besides oxygen therapy to improve the chances of survival for people with advanced COPD.1,3

Other benefits may include:1-3

  • Improved lung function
  • Increased ability to exercise
  • Reduced breathlessness
  • Fewer flare-ups, or exacerbations

Not everyone with COPD is a good candidate for LVRS. In general, it is for people with emphysema who have stopped responding to other medicines. Additionally, it is typically successful for people who:1

  • Are younger than 75 to 80 years old
  • Have not smoked for at least 6 months
  • Are not able to exercise even after completing pulmonary rehabilitation, which is a special program for people with COPD

What are the possible complications of LVRS?

As with any surgery, there are risks linked to LVRS. The most common complication is the risk of air leaks. Air leaks happen when air escapes from the lungs into the chest. To treat this complication, a chest tube is placed into the chest to drain the air. Some people may need another surgery to treat an air leak.1

Other risks include:1

  • Pneumonia
  • Blood clots
  • Infection
  • Heart problems like heart attack or irregular heartbeat

These are not all the possible risks of LVRS. Talk to your doctor about what to expect or if you experience any changes that concern you during the process of getting LVRS.

What to expect from LVRS

Before LVRS, you will be asked to complete several tests to make sure you are a good candidate. This may include:1,3

  • Lung function tests
  • Exercise test
  • Imaging tests of the lungs
  • Heart health tests

If you are considered a good candidate for LVRS after testing, you can find a specialist to complete the surgery. It is helpful to ask your primary COPD doctor for recommendations. During the actual surgery, you are placed under general anesthesia. This means you are fully asleep and on a breathing machine.1

There are different techniques for LVRS, but it is most commonly done with a method called video-assisted thoracoscopy surgery (VATS). VATS is minimally invasive, which can make recovery easier. During VATS, the surgeon makes small incisions in the chest to insert small cameras and surgical tools. The surgeon then removes the damaged lung sections.1,3

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Written by: Juliette Daily | Last reviewed: July 2021.