Lung Volume Reduction Procedures

Both procedures reduce the area of the over-expanded and damaged lung to allow the more normal remaining lung to work more efficiently. This allows patients to breathe easier and have a better quality of life. Whether you are a candidate for one of these procedures will be determined by our team of experts.

Lung Volume Reduction Surgery (LVRS) is most commonly done with VATS (video-assisted thoracoscopy surgery). This involves making several (three to four) small incisions where a camera and instruments are placed to do the surgery. The ribs are not spread with this approach. LVRS can be done on one or both sides depending on your situation. General anesthesia is required and patients are in the hospital for 5-7 days.

Bronchoscopic Lung Volume Reduction (BLVR) is done using a small lighted scope with a camera inserted through your mouth while under general anesthesia. Tiny one-way valves (endobronchial valves) are inserted into the most damaged lung, blocking air from entering but allowing mucous secretions and air to escape. This is typically done on one side. The valves are intended to be kept indefinitely, although can be removed if needed.

Compared to lung volume reduction surgery (LVRS), BLVR is a less invasive procedure. In addition, there are no incisions which can lead to faster recovery and fewer risks compared to a surgical procedure.

In general, the best candidates for a successful lung volume reduction procedure tend to be those who:

• Have severe lung damage (emphysema)

• Are somewhat physically active and able to exercise

• Are former smokers (not currently smoking)

• Have been diagnosed with COPD for at least two years

• Have no other significant health conditions

An ideal candidate for the LVRS procedure will:

• Have severe lung damage (emphysema), particularly in the upper part of the lung

• Have completed a pulmonary rehabilitation program

• Have not smoked for at least 4 months

• Do not have severe heart disease or other health problems that make surgery higher risk

• Do not require larger doses of steroids (prednisone), >20 mg daily

• Do not require over 6L of oxygen at rest

Who may not be a candidate for Lung Volume Reduction Surgery?

People who are born with an inherited form of emphysema, called alpha-1-antitrypsin deficiency-related emphysema, are not likely to benefit from lung volume reduction surgery. A lung transplant may be a better treatment option than lung volume reduction surgery for these individuals.

An ideal candidate for the BLVR procedure will:

• Have severe lung damage (emphysema)

• Have completed a pulmonary rehabilitation program within 2 years

• Have not smoked for at least 4 months and to commit to not smoking after valve placement, as valves may stop working with continued lung destruction

• Do not have severe heart disease or other health problems that make the procedure higher risk

• Do not have frequent COPD exacerbations (frequent courses of prednisone/steroids)

• Do not require larger doses of steroids (prednisone), >15 mg daily

• BLVR can be performed in upper or lower lobe predominant emphysema, alpha-1 antitrypsin disease, and certain patients with homogenous emphysema

Before undergoing LVR, patients must be evaluated by a pulmonologist and thoracic surgeon. This will determine if you are an ideal candidate and which procedure may be best for you.

Required preoperative testing includes:

• Pulmonary function tests
• Six-minute-walk test
• Arterial blood gas to measure levels of carbon dioxide and oxygen in the blood
• CT scans of the lungs
• Echocardiogram
• A lung perfusion scan

Other testing may be required depending on your health and specific situation. To be a candidate, you must have stopped smoking for at least 4 months and have completed a pulmonary rehabilitation program.

What are the Benefits of Lung Volume Reduction Procedures?

Both procedures can result in significant improvements in quality of life, allowing patients to breathe easier and do more. In some cases, it may even allow patients to live longer and decrease the amount of oxygen they need.

Studies have shown that lung volume reduction surgery and bronchoscopic lung volume reduction improve exercise capacity, lung function, and quality of life in selected patients when compared with people who were treated with other methods.

What are the Risks of Lung Volume Reduction Procedures?

There are some risks and common complications associated with LVRS and BLVR.

Risks for Lung volume reduction surgery (LVRS) include:

• Wound infection

• Prolonged air leak into the chest cavity (needing your chest tube in longer than normal)

• Bleeding

• Pain or numbness at the incision site

• Infections such as pneumonia

• Respiratory failure

• Atrial fibrillation (irregular heartbeat that is usually temporary and controlled with medication)

Risks of Bronchoscopic lung volume reduction (BLVR) include:

• Pneumonia

• Respiratory failure

• Pneumothorax (air around the lung)

• COPD Exacerbation

In the days leading up to the procedure, the patient may need to undergo additional tests and imaging studies to ensure that they are healthy enough for surgery. They may also need to stop taking certain medications or make other lifestyle changes in preparation for the procedure.

Overall, the evaluation process before a lung volume reduction procedure is thorough and designed to ensure that the patient receives the safest and most effective treatment possible.

For Lung Volume Reduction Surgery (LVRS):

Patients are typically in the hospital for an average of 7 days, sometimes shorter or longer.  After leaving the hospital, you will not do everything you did before surgery.  Your body will need almost two months to return to a normal activity. Patients should expect to start seeing a benefit (improvement in quality of life, breathing easier) in about 3 months after surgery.

Patients are seen for follow up at 2 weeks, 6 weeks, 6 months and 1 year after the procedure and annually thereafter. 

For Bronchoscopic Lung Volume Reduction (BLVR)

Patients are typically in the hospital for an average of 3 days for close monitoring after the procedure. As the area of more diseased/“bad” lung closes off and allows the good lung to open up, there is closer monitoring for complications during this time. 

Your body will need around 2 weeks – although up to 6 weeks – to recover and ultimately find a benefit. There can be further gradual improvement out to 6 months, thereafter the valves are kept in place indefinitely and can undergo revision if needed. Patients are cleared to return to pulmonary rehabilitation at 2 weeks post-procedure.

Patients are followed closely with telephone calls at 1 week and 2 weeks post-procedure. They are seen in the clinic at 3 months, 6 months, and annually thereafter. We perform studies such as pulmonary function tests, 6-minute walk tests, and CT scans to ensure the valves are working as intended and the benefits are present.

For Lung Volume Reduction Surgery (LVRS):

Your body will need almost 2 months to return to a normal activity. Patients should expect to start seeing a benefit (improvement in quality of life, breathing easier) in about 3 months after surgery.

Patients are seen for follow up at 2 weeks, 6 weeks, 6 months and 1 year after the procedure and annually thereafter.

For Bronchoscopic Lung Volume Reduction (BLVR):

Your body will need around 2 weeks—although up to 6 weeks —to recover and ultimately find a benefit. There can be further gradual improvement out to 6 months, thereafter the valves are kept in place indefinitely and can undergo revision if needed. 

Patients are cleared to return to pulmonary rehabilitation at 2 weeks post-procedure.