Lung Volume Reduction Surgery
This is a surgery used in some people with severe emphysema to improve breathing. This procedure can:
- Reduce the size of an over-inflated lung by taking out small pieces of the damaged lung tissue, about 20-30% of each lung.
- Allow the rest of your lung that works better to expand more fully.
LVRS has been shown to help improve breathing and overall quality of life in patients.
What is Emphysema?
Emphysema is a form of Chronic Obstructive Pulmonary Disease (COPD). There are 2 types of emphysema. Most of the time, it is caused by smoking.
Emphysema – due to smoking
Emphysema begins with damage to the air sacs in the lungs. This results in ‘holes’ in the lung tissue. As air sacs are destroyed, the lungs are able to get less and less oxygen to the bloodstream, causing shortness of breath. The “holes” or abnormally large airs sacs fill easily with air but are not able to empty when you breathe out. The problem of easy filling and poor emptying of the lung leads to the lungs becoming too large making it hard to breathe.
Emphysema does not start quickly. It comes on very slowly. Years of smoking often occur before the start of emphysema. It mostly occurs in people over 45 years of age.
Symptoms include cough, shortness of breath, and trouble with exercise. Doctors can test for this with breathing tests, history, exam, and other tests.
AAT (Alpha Anti-trypsin Deficiency-Related) Emphysema
AAT emphysema is caused by the lack of a protein called alpha1-antitrypsin (AAT) or alpha1-protease inhibitor. This protein is produced by the liver and protects the lungs. Without AAT, emphysema will set in. It affects 5% or less of the people with emphysema. About 100,000 Americans, mostly of northern European descent, have AAT deficiency emphysema. Another 25 million Americans carry a single gene that causes AAT and may pass the gene to their children.
Symptoms of this type of emphysema may begin between 32 and 41 years of age and include shortness of breath and trouble with exercise. Smoking makes this type of emphysema worse. A blood test can tell if a person has this gene. If children have this gene, they may need a liver transplant. Also, a cheek swab test is being used to test for the lack of AAT.
Who is a good candidate for LVRS?
This surgery is not for everyone. It is best used with people who have the lowest risk of complications. The success of LVRS depends on the location or size of the diseased lung tissue. It also depends on the patient’s ability to both exercise and to survive surgery. This surgery works best on those who:
• Are less than 75 years of age
• Have stopped smoking for longer than 6 months
• Have severe shortness of breath even after medical treatment
Before the surgeon decides whether the LVRS is right for you, there are many tests that need to be done. These tests include:
- Chest X-ray
- Pulmonary Function Tests
- Arterial Blood Gas (to measure levels of carbon dioxide and oxygen in the blood)
- High resolution, computed tomography scan (CT scan)
- Oxygen titration
- Six-minute walk
- Cardiopulmonary exercise test
- Cardiac stress test
- Lung Perfusion Scan
Before surgery, patients will need to be able to complete 12 weeks of pulmonary rehab. After surgery, patients will need to do 6 weeks of pulmonary rehab.
What happens in pulmonary rehab?
1. Assessment Phase
a. Initial ECG monitoring (looks at heart rhythm) and 6 minute walk test, fitness assessment, nutritional and psychosocial assessments, and one-on-one teaching sessions.
2. Training Phase
a. Independent or supervised exercise group program
b. Monitored 30 day evaluations and discharge evaluation
c. Work on achieving personal goals that include: nutrition, smoking cessation, physical activity goals, weight loss, and stress reductions
3. Follow-up Phase
a. 3 month and 9 month post discharge follow-ups
b. Keep working on achievement of personal goals
What are the long term goals?
1. Reduce symptoms
2. Greater exercise tolerance and able to complete daily tasks
3. Improve quality of life
4. Reduce healthcare costs
How is the Lung Volume Reduction Surgery done?
There are 2 main ways to do this type of surgery.
- Video-assisted Thoracoscopy (VATS): This is the most preferred way. A VATS procedure uses 3-5 small incisions (1-2 inches) made on both sides of the chest, between the ribs. A small camera is placed through one of the incisions to allow the surgeon to see your lungs. A stapler and a grasper are inserted into the other incisions to remove the most damaged areas of the lung. Surgery can be done on both lungs using the same holes.
- Thoracotomy: This approach uses a larger incision (5-12 inches long) that is made between your ribs. Your ribs are then separated (not broken) and your lungs are seen. Only one lung is done at a time with this approach. If you are having surgery on both lungs, then one incision will be made on each side. This approach is used if the surgeon cannot see your lungs clearly with the camera used in VATS or if there is a lot of scar tissue.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 08/15/2012
Copyright © 08/02/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7392
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