Lung volume reduction surgery

What is lung volume reduction surgery?

Lung volume reduction surgery is an operation to treat emphysema. It is done to improve breathing by removing the most over inflated and diseased parts of the lung. This has two effects: breathing feels easier and healthier parts of the lung can expand and work better. Only certain people benefit from surgery so you will have a detailed specialist assessment before being considered for surgery. Surgery can be done on one lung or both lungs either at the same time or at different times. Please discuss this with your surgeon. If you are suitable, the operation can improve symptoms of breathlessness, improve ability to exercise and prolong your life. The surgery does not cure emphysema, over time your breathing will decline again.

What does the surgery involve?

It is usually a keyhole (VATS) operation and takes about 1 to 2 hours. During surgery you lie on your side with your arm raised. Up to 4 small cuts are made, each about 5cm (2 in) long. These are used for the instruments and small camera to go into the chest. Special staples are used to cut and seal parts of lung that need to be removed. The piece of lung can be removed through one of the small cuts. The wound is closed with dissolvable stitches. 1 or 2 chest drains are put in at the end of the operation and held in placed with a stitch. These remove any fluid or air from around the lung.

If a part of the operation cannot be done keyhole the operation may need to be changed to the open technique (thoracotomy). Open surgery is done with one longer cut under the shoulder blade between 2 ribs. The 2 ribs are parted to get into the chest. One rib may be cut to give more space, ribs are not removed. At the end of surgery the 2 ribs are held back together with strong stitches. The muscles and skin are also stitched back together.

Alternatively, a vertical cut about 15cm long may be made on the front of the chest (median sternotomy). This means the surgeon has to cut through the breastbone and it allows them to see both the left and the right lungs in the same operation. This is the same cut used to do heart bypass surgery.

What is recovery like?

It may take a few weeks for your lungs to fully adapt to the treatment. During the treatment recovery period, you may have some extra coughing, pain and breathlessness. This is normal and usually resolves within 30 to 90 days. The length of time you spend in hospital varies from person to person but usually be between 4 and 10 days. Some people will have a shorter stay and others longer, this is normal.

Recovery in hospital and recovery at home apply to lung volume reduction surgery.

See also sections on:

Pain control Exercise and physiotherapy
What are the risks?

The risks here are a guide; your own risk may vary. You should discuss the risks and benefits of surgery with your surgeon, especially if you are worried. Since you will already have severe lung disease the risks are higher. A minitracheostomy may be recommended to help reduce the risk of a chest infection after surgery for this reason.

General risks of thoracic surgery apply to lung volume reduction surgery.

In addition the following are risks of lung volume reduction surgery:

  • Minor more common risks 

Air leaking from the lung into the chest drain for a few days is common after lung surgery. Occasionally this lasts for longer, possibly weeks. A chest drain will need to be in place until this settles, you may be able to go home with the chest drain still in and come back for regular check-ups until the air leak settles. You may experience an exacerbation of your usual emphysema symptoms such as increased mucous secretions and wheezing. Your kidneys may not work as well after surgery but this is usually temporary and gets better with extra fluid.

  • Major less common risks

A flare up of breathing problems may be severe enough to require help from a ventilator machine. This can be via a face mask with you fully awake, known as non-invasive ventilation (NIV). It may also be need via a tube in the trachea with you under sedation. If you need help breathing via a tube in the trachea for a longer period it may be beneficial to have a temporary tracheostomy. Lung volume reduction surgery is a high risk operation. 1 in 20 die from the surgery and 19 in 20 recover from surgery. This should be weighed against the potential benefits in decided whether or not to proceed.

What are the alternatives to surgery?

Most people with emphysema do not undergo surgery, the usual care for emphysema includes:

  • Not smoking
  • Exercise, there are classes for improving your lung function and learning more about the lungs across the country
  • Finding the right medications (including inhalers) to suit you
  • Managing flare ups wither at home or with the help of your doctor
  • Healthy diet
  • Oxygen or ventilator machines at home

Even if you have surgery, you should continue with these aspects of usual care with the support of your doctor.

It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits you. You are always welcome to seek a second opinion.