Lung Volume Reduction Surgery

In some cases, drugs and lifestyle changes are not enough to manage the symptoms of chronic obstructive pulmonary disease (COPD). If COPD becomes severe and begins to affect quality of life, surgery may be an option. Lung volume reduction surgery (LVRS) is a common type of surgery for COPD.^1,2

What is LVRS?

LVRS involves removing or collapsing damaged parts of the lung. This can help the remaining areas of the lung work better. LVRS targets enlarged (hyperinflated) areas of the lungs where oxygen transfer is not occurring well.^1-4

LVRS is recommended for people who have lung damage mainly in the upper part of the lungs. It can also be used to remove cancers or masses in the lungs.^1-4

LVRS may improve:^1-4

• Lung function
• Quality of life
• Breathing ease
• Exercise tolerance

In the past, the main type of LVRS was a thoracotomy. This open surgery involved making a large incision (cut) in the skin and going through the ribs and chest wall to get to the lungs. The surgeon would then remove the damaged part of the lung.^1,5-7

Thoracotomy is a major surgery that can have many complications. Fortunately, newer technology has allowed for different approaches.^1,5-7

Minimally invasive types of LVRS

Today, tiny cameras and tools make it possible for surgeons to get to the lungs through smaller incisions in the skin or through the airways. This helps avoid open surgery, which can have more complications. Minimally invasive approaches lead to less post-surgical pain, earlier recovery, and shorter hospital stays. They are also less expensive.^3-8

For example, in video-assisted thoracoscopic surgery (VATS), a surgeon makes tiny incisions in the skin of the chest. Then the surgeon can use small tools to access the lungs.^4,6,7

In bronchoscopic lung volume reduction (BLVR), the surgeon makes no incisions at all. Instead, they insert a flexible, tiny camera and tools through the nose and mouth to get to the lungs. The surgeon then places a one-way valve in the damaged area. There are 2 types of valves available:^3-5,8

• Zephyr endobronchial valve
• Spiration valve system

This prevents air from getting into this part of the lung. Over time, the lung will collapse on itself. This collapsed area of the lung then acts as though it had been removed.^3-5,8

How does LVRS help treat COPD?

The exact way LVRS helps treat COPD is not known. However, some of the most common theories include:⁶

• Improving coordination between the lungs and rib cage to help with air outflow
• Making the diaphragm muscles and muscles between the ribs work better, leading to better airflow
• Reducing the amount that the lungs can hyperinflate during exercise
• Supporting better heart function, filling, and pumping of blood
• Decreasing inflammation and inflammatory proteins throughout the bloodstream

What are the possible side effects of LVRS?

Minimally invasive types of COPD surgery have fewer side effects than open surgery. But, as with any procedure, there are still risks. Possible side effects of LVRS include:^1,5-7

• Pain
• Air leaking from the lungs into the chest cavity
• Trouble breathing or the need for breathing support
• Incision site infection (if an incision is made)
• Pneumonia
• Collapsed lung (pneumothorax)
• Blood clots

These are not all the possible side effects of LVRS. Talk to your doctor about what to expect with LVRS. You also should call your doctor if you have any changes that concern you about LVRS.

Things to know about LVRS

As with most procedures, there are a few steps needed to prepare for LVRS. Most people will have pulmonary function tests (PFTs) and blood tests beforehand. Chest imaging, like chest CT, also can be used to help the surgeon decide on the best approach to the damaged tissue.^1,6

Exercise tests, 6-minute walk tests, and heart function tests may also be required. Your doctor will let you know what steps are needed to determine the safety of the procedure and how your body might tolerate it.^1,6

Not everyone is a good candidate for LVRS. Certain health issues may make the procedure unsafe. Common reasons a person might not be able to get LVRS include:^1,2,6

• Issues with bleeding or blood clotting
• Masses in the lungs or airways
• Severe trouble breathing
• High blood pressure in the blood vessels carrying blood between the lungs and the heart (pulmonary hypertension)
• A current, heavy smoking history
• Issues completing pulmonary rehabilitation prior to surgery
• Problems undergoing anesthesia
• Other serious health issues, such as some heart conditions

You and your doctor will work together to weigh the benefits and risks of LVRS to decide whether it is right for you.