Lung Volume Reduction Surgery (LVRS)

What is lung volume reduction surgery (LVRS)?

Lung volume reduction surgery (LVRS) is a surgical procedure that removes parts of your lungs to help them work more effectively. LVRS takes out parts of your lungs that are damaged and trapping air.

LVRS reduces the size of your lungs and allows air to reach healthy parts of your lungs. This means more oxygen from the air can get into your bloodstream and to your tissues.

Providers recommend lung volume reduction surgery to relieve symptoms in certain people with severe emphysema, a type of chronic obstructive pulmonary disease (COPD) that can trap air in pockets in your lungs.

Providers only recommend LVRS after you’ve quit smoking, and medications and pulmonary rehabilitation aren’t relieving your symptoms. It isn’t a cure for COPD and won’t extend your life. The goal is to help you feel better and improve your quality of life.

Who qualifies for lung volume reduction?

Studies suggest only certain people benefit from LVRS. You might be eligible if you:

• Are younger than 75.
• Have severe shortness of breath (dyspnea), even with medications and pulmonary rehabilitation.
• The upper area of your lungs (apex) is affected the most, with less damage in other areas of your lungs.
• Your lungs are overinflated and have evidence of severe air trapping.
• Don’t currently smoke and haven’t smoked in four months or longer.
• Are able to complete six to 10 weeks of pulmonary rehabilitation before surgery and 10 to 12 sessions after surgery.

What’s the difference between open surgery and bronchoscopic lung volume reduction?

To reduce lung volume, a provider can remove the damaged parts of your lung through cuts (incisions) in your chest using a thoracoscopy or a sternotomy (open surgery). Or they can use special valves that allow air to escape but not get trapped (bronchoscopic lung volume reduction). Your surgeon will carefully evaluate your specific situation to determine the best approach.

Thoracoscopy and sternotomy

If a provider is going to remove damaged parts of your lungs, they’ll use one of two techniques:

• Thoracoscopy. A surgeon makes three to five small cuts on both sides of your chest, between your ribs. A thoracoscopy is usually done as video-assisted thoracic surgery (VATS). Your provider will insert a videoscope through one of the incisions to allow them to see your lungs. A thoracoscopy is less invasive than a sternotomy.
• Sternotomy. During a median sternotomy, a surgeon cuts through your breastbone to open your chest. A surgeon can access both lungs through the same incision with this approach. Recovery from a sternotomy is usually less painful than recovery from thoracoscopy.

Which tests will I have before lung volume reduction surgery?

You may need a number of tests to determine if you’re a good candidate for LVRS based on your symptoms and characteristics of the disease. These include:

• Imaging. Chest x-rays and high-resolution CT scans (computed tomography scans) can help your provider know if a large amount of air is trapped in your lungs, and where the worst damage is.
• Pulmonary function tests. LVRS might be more likely to help people with an FEV1 (forced expiratory volume in one second) of less than 45% on spirometry tests.
• Exercise tests. A metabolic exercise stress test (cardiopulmonary exercise test) and six-minute walk test can help your provider understand the level of exercise you can tolerate.
• Lung diffusion test. Your provider may want you to have a DLCO (diffusing capacity for carbon monoxide) that’s above 20% of the predicted value.
• Cardiac (heart) tests. An electrocardiogram (EKG), an ultrasound of your heart (echocardiogram) and a stress test can help your provider understand how well your heart is working.
• Ventilation/perfusion scan (V/Q scan) and arterial blood gas tests. These tests can give your provider additional information about how well your respiratory system is working.

What happens before LVRS?

Your provider will give you instructions on how to prepare for LVRS. Following their directions closely can reduce your risk of complications. Before LVRS, your provider may ask you to:

• Not eat anything for eight hours before the procedure (fast).
• Not take certain medications or alter your medication schedule.
• Ask someone to drive you home after a few days in the hospital.

Make sure you tell your provider about all the medications you take, including over-the-counter (OTC) and herbal supplements.

What happens during lung volume reduction surgery?

Just before the start of the procedure, a provider might position you to lie on your back or your side. They’ll give you anesthesia that’ll keep you asleep for the surgery.

During a sternotomy or VATS, your surgeon will:

1. Make incisions either in the middle of your chest (sternotomy) or between your ribs (VATS).
2. Use a surgical stapler to remove sections of your lungs. This separates the damaged section and creates a reinforced (buttressed) closure along your healthy lung.
3. Place tubes to drain fluid from your lungs.
4. Close the incisions and cover them with surgical dressing.

How long does lung volume reduction surgery take?

Depending on which kind of procedure you have, LVRS can take one to three hours.

What happens after LVRS?

A team of healthcare providers will monitor you until you’re awake. You’ll recover in the hospital for several days after the procedure.

What are the advantages of lung volume reduction surgery?

Benefits of lung volume reduction surgery can include:

• Better quality of life.
• Improved lung function.
• Reduced shortness of breath.
• Improved ability to exercise.
• Improved breathing mechanics.
• Reduced pressure on your diaphragm.

What are the risks of lung volume reduction surgery?

While healthcare providers follow procedures to minimize the complications, all surgery comes with risks. Complications of lung volume reduction surgery include:

• Reactions to anesthesia.
• Collapsed lung (pneumothorax).
• Air leaking from along the closure (suture) line.
• Pneumonia or other infections.
• Heart attack (myocardial infarction).

How serious is a lung reduction surgery?

Any surgery on your lungs is serious and has risks. The mortality (death) rate from LVRS is 3% to 5%.

What is the recovery time for lung volume reduction surgery?

You should expect to stay in the hospital for three to seven days after LVRS. You’ll start pulmonary rehabilitation within the first few weeks after surgery.

How successful is lung volume reduction surgery?

LVRS provides symptom relief and improves quality of life in about half of people who get it. LVRS isn’t a cure for emphysema, so success is determined by whether or not you feel better after surgery. Symptom relief usually lasts two to five years.

What is the life expectancy after lung volume reduction surgery?

Your life expectancy (how long you can expect to live) won’t change after lung volume reduction surgery. But you should feel better and your quality of life may improve.

How can I take care of myself after LVRS?

Ways you can take care of yourself after LVRS include:

• Follow your provider’s directions on when to rest and when to return to physical activity.
• Attend all of your follow-up appointments with your provider.
• Attend all recommended pulmonary rehabilitation (physical therapy) appointments.
• Contact your provider with any questions.

When should I call my healthcare provider?

Call your provider with any questions or concerns before or after surgery. Go to the emergency room right away if you have signs of an infection, collapsed lung or other serious complications, including:

• Fever.
• Chest pain.
• Severe difficulty breathing.
• Blue skin, lips or nails (cyanosis).

A note from Cleveland Clinic

LVRS can improve symptoms for some people with emphysema. While it’s not a cure, it can improve your quality of life and allow you to do more things you enjoy. If your provider recommends LVRS, they think you’re a good fit for the procedure — but be sure you think LVRS is a good fit for you, too. Ask your provider about the benefits and risks of LVRS — having all the information can help you make important decisions about your care.