Lung Volume Reduction Surgery (LVRS) is a specialized procedure designed to treat severe emphysema, a progressive form of Chronic Obstructive Pulmonary Disease (COPD). Emphysema damages the air sacs, causing them to lose elasticity, which leads to air trapping and hyperinflation. This trapped air pushes down on the diaphragm, hindering the function of remaining healthier lung tissue. LVRS addresses this by surgically removing the most diseased, non-functional portions of the lung to reduce the overall volume of the chest cavity. This allows the diaphragm to return to an optimal, domed shape, enhancing breathing efficiency and permitting less-damaged lung tissue to expand fully.
Identifying Candidates for Surgery
LVRS is reserved for a highly specific subset of individuals who meet rigorous medical criteria. A foundational requirement is severe emphysema, often measured by a Forced Expiratory Volume in one second (FEV1) less than 45% of the predicted value. Candidates must also have quit smoking for at least six months prior to evaluation, as continued tobacco use compromises both surgical outcome and long-term survival.
The anatomical distribution of the disease is a crucial factor, assessed through a high-resolution computed tomography (CT) scan. The best outcomes occur in patients with heterogeneous emphysema, where damage is predominantly concentrated in the upper lobes of the lungs. Removing this non-uniform, upper-lobe diseased tissue yields the greatest mechanical benefit.
Conversely, patients with diffuse, homogeneous emphysema or very low exercise tolerance may not benefit or may face a higher risk. Exclusion criteria include significant co-existing conditions, such as severe pulmonary hypertension, which is a high mean pulmonary artery pressure, or other serious systemic diseases that compromise survival. Furthermore, all patients must complete a comprehensive pre-operative pulmonary rehabilitation program to strengthen respiratory muscles and ensure they are in the best physical condition for surgery.
How Lung Volume Reduction is Performed
LVRS excises approximately 20 to 30 percent of the most damaged and hyperinflated lung tissue. This targeted removal physically shrinks the lung volume, reducing pressure on the diaphragm and chest wall structures. The remaining, less-diseased tissue gains more space to expand, improving compliance and gas exchange capabilities.
Surgeons employ two primary approaches to access the chest cavity. The first is the traditional median sternotomy, involving a large incision down the center of the sternum to provide wide access to both lungs simultaneously. This technique is now less common due to its invasiveness and longer recovery time.
The preferred modern method is Video-Assisted Thoracoscopic Surgery (VATS), which is a minimally invasive approach. VATS involves making several small incisions between the ribs, through which a camera and specialized surgical instruments are inserted. Using surgical staplers, the most diseased portions of the lung are carefully identified, sealed, and then removed from the chest cavity.
LVRS is most commonly performed as a bilateral procedure, addressing diseased areas in both lungs during the same operation. Surgical staplers simultaneously cut and seal the lung tissue, often using a reinforcing material called a buttress to minimize the risk of a persistent air leak. This meticulous excision of non-functional tissue leads to improved airflow and reduced shortness of breath.
Life After the Operation
Following the procedure, patients require a hospital stay of 7 to 14 days for initial recovery and monitoring. The most common immediate post-operative concern is a prolonged air leak from the stapled lung tissue, requiring chest tubes until the leak seals. Other potential complications include pneumonia, infection, respiratory failure, and a reported perioperative mortality rate between 3 and 10 percent.
Intensive post-operative pulmonary rehabilitation is a component of the recovery process. This structured program helps patients regain strength, improve exercise tolerance, and learn new breathing techniques to maximize the surgical benefit. Returning to normal daily activities is a gradual process that can take several weeks to months, depending on pre-operative health and the absence of complications.
For appropriately selected candidates, the long-term results of LVRS are significant and durable, leading to substantial improvement in quality of life. Patients experience a marked reduction in shortness of breath and an enhanced ability to perform physical activities, often measured by an increased six-minute walk distance. This improvement in exercise capacity and pulmonary function is directly linked to the restored mechanical advantage of the chest and diaphragm.