What is Lung Volume Reduction Surgery?
Lung volume reduction surgery or LVRS is a surgical process by which damaged lung tissues are removed to treat emphysema. Emphysema is a type of chronic obstructive pulmonary disease (COPD) in which the air sacs in the lungs become damaged and stretched causing chronic cough and difficulty in breathing. The expanded lung pushes the diaphragm and other surrounding organs causing difficulty in breathing.
Emphysema is mostly caused by smoking but can also be genetic in few cases.
LVRS is recommended by a physician and performed only in cases where the symptoms persist after trying all other medical treatments including medications and pulmonary rehabilitation. Through surgery, around 20 to 30% of the most diseased portions of the over-expanded lung can be removed.
After the surgery, the lung comes back to normal size and ensures other organs such as the diaphragm, and rib cage is also back to normal shape and can work efficiently. Post-surgery the patients experience a better quality of life by improvement in breathing and are better able to exercise.
Lung Volume Reduction Surgery Criteria:
The physicians will have to conduct many checkups on the patient and review certain criteria before recommending LVRS surgery:
- A complete lung function testing, chest x-rays, and CT films can be prescribed to help access the severity of the disease
- Patients must be in an acceptable weight range to undergo LVRS treatment. A BMI ≤31.1 for males and a BMI ≤32.3 for females is recommended to go ahead with the procedure provided all other criteria are met.
- The patient is required to quit smoking at least six months before surgery.
- Patients with a history of heart surgery or lung surgery are not eligible for the surgery. (Patients undergoing this surgery should not have other major diseases such as heart failure, cancer, severe osteoporosis, kyphosis or curvature of the spine, kidney failure, severe pulmonary hypertension, or other lung diseases such as asthma, pulmonary fibrosis, or bronchiectasis).
- For some patients who have inherent emphysema related to a deficiency in alpha 1 trypsin, a lung transplant may be a better treatment option than lung volume reduction surgery.
Lung Volume Reduction Surgery Procedure:
LVRS can take up to 3 to 4 hours of total operational time. Cardiothoracic surgeons are experienced in performing this surgery either via a large incision called thoracotomy or through several small incisions using a special scope called video-assisted thoracoscopic surgery. General anesthesia is administered before the surgery. The chest is opened to expose the lung one side at a time. Using surgical procedure the most diseased areas of the lung are removed and the remaining lung is sealed back with surgical staplers. It is also common to place four chest tubes in each chest cavity to allow drainage and help in the re-expansion of the lungs. The chest is then closed and the patient is monitored overnight in the ICU.
Lung Volume Reduction Surgery Recovery
A patient who has undergone LVRS should expect to stay in the hospital for at least 5 to 10 days after lung reduction surgery. Within the first 4 to 6 weeks after surgery, Pulmonary rehabilitation usually begins and is a very important part of the recovery process.
Since the most diseased lung tissue is removed the least diseased tissue needs to maximize its breathing capacity. Rehabilitation exercises enable the muscles used in breathing to regain their function. Once the lung size is reduced the rib cage and diaphragm are also able to return to their normal shape and are better able to contract and expand, easing the breathing process of the patient.
Improvement in breathing can be noticed within six to eight weeks post-surgery and this improvement is ongoing as the exercise program continues. Therefore exercise plays a very important role in the recovery by helping to retrain the chest wall muscles and regain their physical strength.
In a few cases, patients may not see an improvement in their breathing even after the surgery. They might still have to be on supplemental oxygen post-operatively.
However, there are enormous studies where LVRS has improved exercise capacity, lung function, and quality of life in patients when compared with those patients who were treated non-surgically.
Probable Complications in LVRS Surgery
- Anesthesia can be risky for COPD patients undergoing LVRS.
- A patient with poor healing of tissues has a risk of thinned-out emphysematous lungs.
- There could be a risk for persistent air leaks from the resected lung. A prolonged chest tube drainage is required in such cases and sometimes the patients are also discharged with the chest tubes still in place.
- Pneumonia is a severe complication very often known in emphysema patients. The severity of pneumonia can also lead to death in a few cases.
LVRS Surgery in Hyderabad and India
Lung volume reduction surgery is performed by specialists in cardiothoracic surgery, who need to work closely with other specialists in pulmonary medicine and rehabilitation care before and after surgery.
Dr. PV Naresh is ranked among the best cardiothoracic surgeons in Hyderabad and a well-renowned surgeon in India with an experience of more than 20 years in LVRS and other cardiothoracic surgeries. Apart from his surgical experience, he has the testing and medical expertise to help decide which treatment option is appropriate for the patient. He works with Yashoda hospitals’ which is a super specialty hospital with infrastructure available for lung and heart transplants. Lung volume reduction surgery, therefore, can be easily performed with other specialists closely monitoring. Here the patients are cared for by a team of doctors, nurses, and therapists who specialize in lung diseases.