Lung volume reduction surgery for COPD

Overview

Lung volume reduction surgery is an option for some people with severe, advanced emphysema, a type of chronic obstructive pulmonary disease (COPD). In these people, the lungs are hyperinflated and cannot expand effectively. During lung volume reduction surgery, between 20 and 30 percent of the most diseased part of each lung is removed, giving the remaining, healthier parts of the lung more room to expand. Lung volume reduction surgery may also be referred to as pneumoplasty or bilateral pneumectomy.

Not everyone with emphysema is a good candidate for lung volume reduction surgery. In fact, it is difficult to qualify for this operation. In order to be a candidate for lung volume reduction surgery, you must have significant airflow obstruction and hyperinflation, but some areas of healthier lung to preserve. Doctors will also pay attention to where in the lungs your emphysema is worst. You must be in good cardiovascular health and have stopped smoking at least six months previously. Preference is given to those with poor exercise capacity despite following the medical regimen closely and participating in rehabilitation. Those over 75 years of age are not considered good candidates. Finally, you must be strongly motivated to work hard at recovery by exercise and rehabilitation therapy starting immediately after surgery.

Lung volume reduction surgery is not a cure for COPD, but it may treat some symptoms.

What does it involve?
Your doctor will perform a number of breathing tests, blood tests, and imaging scans to find out whether lung volume reduction surgery can improve your condition. You and your doctor should decide together whether lung volume reduction surgery may be right for you. Do not be afraid to ask questions about any aspect of the surgery or recovery.

Once your lung volume reduction surgery is scheduled, you may be enrolled in a preoperative pulmonary rehabilitation program in order to speed your recovery and avoid complications. Spend the weeks before surgery preparing by eating nutritious meals and staying as active as possible, even if you can only take short walks. Do not smoke, and limit your consumption of alcoholic beverages to one or two per day. Being in top condition for surgery will make recovery easier.

You will be given instructions to stop eating a few hours or possibly the night before surgery. When you arrive at the hospital, vital signs will be taken, blood will be drawn for testing, and some scans may be taken of your chest. When it is time for the surgery, you will receive an intravenous (IV) line and anesthetic medication to make you sleep.

There are several techniques used in lung volume reduction surgery. In video-assisted thoracoscopic surgery, the surgeon makes several small incisions on the side of your chest in order to insert a videoscope and instruments. In thoracotomy, used for single lung procedures, one incision is made between your ribs on one side. The ribs are separated to allow access to the lung. In sternotomy, the surgeon cuts through the breastbone (sternum) to open the chest.

A nurse or doctor will explain how to care for your wound or wounds. Depending on your condition and the surgical technique used, you may spend five to 10 days in the hospital recovering from lung volume reduction surgery.

Rehabilitation is a vital part of recovery from lung volume reduction surgery. You should expect to be up and walking soon after surgery, and to begin postsurgical pulmonary rehabilitation therapy within a few days or weeks after surgery. Even if you do not feel up to being active, walking and exercising are necessary in order to keep your recovery period as brief and comfortable as possible.

Once you return home, it will take a few weeks to recover completely from surgery before you can return to work and other normal activities.

Intended Outcomes
In the right candidate, lung volume reduction surgery can improve breathing, lung function, and quality of life. It can also decrease the need for supplemental oxygen therapy[LINK].

Results
A study published in 1996 followed the recovery of 17 people with emphysema who received lung volume reduction surgery. After three months, most participants showed significantly improved lung function and quality of life.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

Lung volume reduction surgery can be painful, and you will most likely need pain medication for some weeks during recovery.

Possible complications of lung volume reduction surgery include pneumonia and parenchymal air leaks, or leaks within your lung, which may prolong your stay in the hospital.

Call your doctor immediately if you notice signs of infection such as swelling, redness, increased pain, or bleeding from the surgical wound.

Links

COPD: Lung Volume Reduction Surgery - Topic Overview – WebMD
http://www.webmd.com/lung/tc/copd-lung-volume-r...

Lung volume reduction surgery – Mayo Clinic
http://www.mayoclinic.org/tests-procedures/lung...

Lung Volume Reduction Surgery – University of Maryland Medical Center
http://umm.edu/programs/thoracic/services/lvr

Lung Volume Reduction Surgery – Cleveland Clinic
https://my.clevelandclinic.org/services/heart/s...

Lung Volume Reduction Surgery for Emphysema – University of Southern California Department of Cardiothoracic Surgery
http://www.cts.usc.edu/lungvolumereductionsurge...

Lung volume reduction surgery. Case selection, operative technique, and clinical results. – Annals of Surgery
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC123...