Lung volume reduction surgery (LVRS) is a treatment aimed at helping people breathe easier when chronic obstructive pulmonary disease (COPD) has damaged a significant portion of a lung.
Removing the portion of the lung most harmed by the disease allows healthier parts of the lung to work more efficiently.
Only certain people with COPD are good candidates for the procedure. The surgery requires a short hospital stay and several weeks of recovery as well as rehab. The outlook is good for a majority of LVRS patients.
Learn who’s eligible for this procedure, how it works, and what to expect from long-term recovery.
The best candidates for LVRS:
- are younger than 75 years old
- have severe lung damage caused by COPD (refers to various lung diseases like emphysema and chronic bronchitis)
- have not smoked for at least the previous 6 months
- are unable to exercise after going through pulmonary rehabilitation
A pulmonologist (lung specialist) and thoracic surgeon will evaluate your case to determine if you’re a good candidate for LVRS. This evaluation includes a review of your medical history and current symptoms as well as several tests of your lung and heart health, including:
- pulmonary function teststo measure how well your lungs are working
- 6-minute walk test to measure exercise tolerance
- arterial blood gas test to check for oxygen and carbon dioxide levels in the blood — signs of how well the heart, lungs, and kidneys are working
- computed tomography (CT) scans of the lungs to assess the location and severity of lung tissue damage
- electrocardiography (ECG) to measure the heart’s electrical system
- echocardiogram to view your beating heart and gauge your heart’s health
- cardiopulmonary exercise test to further evaluate heart and lung function
Consider getting a second opinion from another specialist or surgeon if a primary care doctor decides you are not eligible.
LVRS has potentially serious complications, including:
- air leak, in which air continuously enters the chest cavity from the lung
- hypoxia, a condition in which there is an insufficient oxygen level
- infection, including pneumonia
- cardiovascular problems, such as arrhythmia, heart attack, or blood clots in the lung (pulmonary embolism)
- pulmonary problems, including acute or chronic respiratory failure
A 2021 review of people who underwent LVRS found that
The cost of a lung volume reduction surgery can run around $25,000. This cost can vary based on numerous factors, including:
- geographic location
- expertise of the surgeon
- insurance coverage
Medicare and most health insurance companies will cover a majority of these costs if you meet certain criteria. You may be covered by Medicare if you’re not considered high risk and have severe non-upper lobe emphysema with low exercise capacity.
Preparing for LVRS involves making important lifestyle changes, including:
- Plan to spend about a week or so in the hospital, as LVRS is an in-patient procedure.
- Arrange your work schedule to accommodate outpatient pulmonary rehabilitation.This will likely be scheduled for 4 to 12 weeks about two to three times per week. Each session lasts about an hour or so.
- Arrange transportation to and from the hospital for the surgery and later to and from the rehab sessions if you are unable to get there on your own.
- Arrange to have help at home for the first several days after surgery. This may include other steps, such as setting up a sleeping area that will not require you to climb stairs at first.
- Stop smoking for at least six months before surgery.
- Make sure your health insurance covers the procedure and outpatient rehab at the locations you have chosen. Some facilities and programs may be covered, while others are not.
There are a few different types of LVRS. All are performed under general anesthesia.
The two main procedures are a median sternotomy and a video-assisted thoracic surgery (VATS).
This is also known as open surgery. It’s often used when both lungs are being operated on.
The procedure involves the following steps:
- An incision is made in the skin and tissue down the midline of the sternum.
- The surgeon uses a surgical saw to cut through the sternum, exposing the chest cavity.
- The damaged lung tissue is removed.
- Chest drains are placed before the incision is closed to collect excess air or fluid from the surgical site.
- The surgeon may use titanium wires or a titanium plate to reattach the sternum.
- The outer incision is closed with sutures.
VATS is a less invasive procedure than traditional open surgery.
The procedure includes the following steps:
- One small incision is made in the side of the chest wall.
- A thorocoscope (fitted with a tiny video camera) is inserted through the incision to give the surgeon a view of the lungs.
- Two other small incisions are made in the side of the chest wall.
- Forceps and a surgical stapling device are inserted into the other incisions to remove the diseased portion of the lung.
- When the affected lung tissue has been removed, the incisions are closed with sutures.
Depending on the facility, your general health, and the absence or presence of any complications, you can expect to stay in the hospital about 5 to 10 days after the procedure. During this time, you will have small tubes inserted in your chest to help your lungs expand.
Full recovery from the procedure may take 8 to 12 weeks. During your recovery period, you will likely need to outpatient pulmonary rehabilitation.
After pulmonary rehab, you should gradually be able to return to normal activities. You should be able to exercise longer and with more intensity than you did before as well as have fewer symptoms, such as coughing and shortness of breath.
Follow up with a doctor or pulmonary specialist regularly to monitor your lung health with pulmonary function tests and other screenings. These follow-ups and screenings will likely need to continue for the rest of your life.
LVRS can significantly extend your longevity and improve your quality of life.
Other research suggests that most LVRS patients enjoy a noticeable improvement in breathing, exercise ability, and overall
LVRS is a major procedure, but it has a good track record of success and may help you breathe easier and enjoy a greater quality of life.
In many cases, LVRS is covered by Medicare and other health insurance providers. If your breathing, exercise tolerance, and quality of life have been hampered by COPD, talk with a doctor about whether LVRS could be an option for you.