Lung volume reduction surgery (LVRS)
For some people with chronic obstructive pulmonary disease (COPD), lung volume reduction surgery may be recommended.
If you have emphysema, this surgery can help to make your breathing more comfortable and improve your quality of life. But it’s a significant operation and does carry risks.
What is emphysema?
Healthy lungs are made up of millions of tiny air sacs with elastic walls called alveoli. This is where oxygen is taken into the body and the waste gas carbon dioxide is expelled. Cigarette smoke and other particles you breathe in can damage the walls of these air sacs.
If you have COPD, the walls of these air sacs are damaged. The sacs break apart and merge into each other. This makes holes in the lungs, a process called emphysema.
The damaged parts of the lung are baggy and trap air. If you have emphysema, when you breathe in, the damaged part of your lung inflates more and can get in the way of the healthier parts of your lung.
This increase in the amount of air inside your chest is called hyperinflation. You can find it uncomfortable to breathe as your chest becomes hyperinflated.
Lung volume reduction surgery (LVRS)
LVRS is an operation which removes the worst affected areas of your lung so that the healthier parts of your lung can work better. Also, by removing the ‘swollen’ air spaces, less air is trapped so your chest and diaphragm can relax down to a more normal level and your breathing is more comfortable.
Your surgeon will make a cut in one side of your chest to use a special tool to cut and staple your lung at the same time. This will seal it and prevent or reduce any air leaks. You will be given a general anaesthetic and will stay in hospital for about 10 days to recover.
Benefits and risks
Clinical trials have shown that when people are carefully selected to make sure they are suitable, there are many benefits. The operation can help them live longer, increase their ability to exercise and improve their quality of life, compared with people who don’t have the operation.
This is a significant operation and it does carry a risk of complications that could be life-threatening. This is why people will only be selected as suitable for this operation if they meet certain criteria. It can also mean a long stay in hospital to recover from the operation.
Who is suitable?
LVRS is only a suitable treatment for a minority of people who have COPD. It is only effective for emphysema and you may not be suitable if you have other lung conditions such as bronchiectasis and asthma.
You may be offered this if:
- you have a particular pattern of emphysema, and
- you have a suitable pattern of lung function, and
- you are well enough to cope with the operation. For example, if you are housebound, you probably won’t be well enough to benefit. In this case, ask your health care professional to review your treatment, such as stopping smoking, going to pulmonary rehabilitation and taking the best medication for you.
To see if you are suitable, your health care professional will arrange:
- a CT scan, which is a special X-ray to get a picture of a cross-section of your body. This is to find out if your emphysema is patchy, with areas that can be removed.
- lung function tests to measure
- how good your lungs are at taking in oxygen. This is called gas transfer.
- how much air is left in your lungs after a maximum breath in and out. This is called your residual volume.
- a test to measure your ability to exercise. If you can’t walk 140 metres – the length of one-and-a-half football pitches - in six minutes, it may not be safe to go ahead with the operation.
- They may also arrange a lung perfusion scan sometimes called a VQ scan. The scan works by injecting you with a special material that shows up areas of your lung that don’t have much blood supply when they are scanned. These areas are not helping your breathing, so the test will help to decide where and when to operate.
The results of these tests and a discussion with your health care professional will decide whether the operation is suitable for you.
How effective is LVRS compared to other treatments?
LVRS can be very effective, and dramatically improve how short of breath you feel. If you have COPD, it is one of the few treatments that can help you to live longer and improve your quality of life.
Results do vary from person to person. There can be complications such as air leaks and infection. Experts estimate that about 20% of people having the procedure don’t feel that they have benefited, but most people have a good response.
Where is the operation carried out?
LVRS is carried out in specialist surgical units. If you have emphysema and would like to know more, ask your GP about being referred to a specialist centre.
New forms of lung volume reduction
New techniques are being trialled to treat emphysema using a fibre optic camera, called a bronchoscope.
One technique uses one-way valves which can be placed in your lungs to block off damaged parts. Early evidence shows that valves can sometimes be as good as surgery, so you can avoid an operation. This is currently being researched – valve treatment is not yet widely available. To see if you are suitable, you would take the same tests as for LVRS.
These techniques are also being evaluated in specialist centres and if you are interested in them, talk to your GP or consultant.