Lung Volume Reduction Surgery (LVRS), involving removal of sections of damaged lung tissue, has shown promising results for patients with end-stage emphysema. Not all patients with advanced emphysema are candidates for lung volume reduction surgery. For patients who do not qualify for LVRS other options for treatment, include redirection of airflow by means of bronchoscopically implanted stents and valves. These procedures enable trapped air to escape and improve overall lung function.
Emphysema Treatment
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Dr. Lyall A. Gorenstein, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of Columbia University Department of Surgery -
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Dr. Lyall A. Gorenstein, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of Columbia University Department of SurgeryEmphysema can be treated with video-assisted thoracic surgery. During lung volume reduction surgery (LVRS), one incision permits access of the viewing instrument (thoracoscope). Forceps and a surgical stapling instrument are used to remove the affected tissue through two other incisions.
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NewYork-Presbyterian Hospital answeredSee All 2 AnswersLung volume reduction surgery (LVRS) is an innovative surgical treatment for select patients with severe emphysema, one of several respiratory disorders labeled as chronic obstructive pulmonary disease (COPD). The goal of LVRS is to remove the worst areas of damaged lung tissue so that the remaining tissue can function better. This surgery can be performed using an open surgical approach (cutting through the breast bone to open the chest) or by a minimally invasive, video-assisted thoracic procedure. This method uses 3-5 small incisions to allow the surgeon to insert specially designed instruments between the ribs and into the chest. With either method, 25 Percent-30 Percent of the most damage regions of the lung volume are removed. Scientists believe that by surgically removing functionally useless tissue, air will move in and out of the remaining lung more readily, thereby easing symptoms associated with advanced emphysema and improving overall lung function.
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Reston Hospital Center answeredThere is no cure for emphysema, but there are treatment options available. If you're a smoker, you may be able to slow the progression of the disease a great deal by quitting. You can also improve your symptoms and avoid complications by taking certain medications. Almost everyone who is diagnosed with emphysema can benefit from a pulmonary rehabilitation program as well. This involves living a healthier lifestyle and educating yourself about emphysema in order to improve your quality of life. For severe cases of emphysema, surgery may be able to help improve your breathing, and as a last case scenario, a lung transplant may be an option as well. Talk to your doctor about finding the right treatment for you. -
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Reston Hospital Center answeredThere are several medications that may be able to help treat your emphysema. Bronchodilators and inhaled steroids are often used to help you breathe easier. They work by relaxing your airways and relieving inflammation. Unfortunately, these medications aren't effective for everyone with emphysema. Other medications can be used to help prevent further complications. For example, inoculations against the flu and pneumonia will help prevent you from developing either of these conditions, both of which can make your emphysema much worse. Antibiotics work similarly by treating bacterial infections that may also cause complications. People suffering from both gastroesophageal reflux disease (GERD) and emphysema may find some relief from using medications to treat their GERD.
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Reston Hospital Center answeredThere are several reasons why lung transplants are seldom used when it comes to treating emphysema. For one, there is a lack of donor lungs available. For another, to be eligible the patient must be expected to live no more than 2 years without a transplant, but be considered a good risk to survive the operation. Following the operation, the patient's immune system has to be suppressed for the rest of his or her life. This can leave the person highly susceptible to infection. These reasons, combined with the cost of a transplant and all the complications that accompany any type of surgery, make this option uncommon for treating emphysema. Fortunately, there are other treatments that can be very helpful, such as lung volume reduction surgery.
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If you are interested in being evaluated for lung volume reduction surgery, discuss your interest in LVRS with your primary physician, who will be asked to provide your medical information, including history, pulmonary function, and x-ray studies.
The staff will review that information to determine whether you're a candidate for an on-site evaluation. If you qualify, you will be invited to the center for two days of outpatient testing, including:- Chest x-ray
- Chest CT scan
- Perfusion scan of lungs
- Blood tests (alpha-1 antitrypsin, cotinine level)
- Complete pulmonary function test with lung volumes by plethsymography
- Room air arterial blood gas
- Dobutamine stress test of heart
- Cardiopulmonary exercise test
After the completion of these tests, your review for the procedure will conclude with examination by a pulmonologist and surgeon who make final decisions about your eligibility to proceed with lung volume reduction surgery. All patients, whether surgical candidates or not, are evaluated for and prescribed a pulmonary rehabilitation program by the rehabilitation medical physician during their evaluation at the center.
Patients accepted for surgery are referred to a six-week program of outpatient pulmonary rehabilitation prior to surgery as well as a preoperative checkup in the final week of the program. At this time surgical consent is obtained, surgery scheduled and preoperative testing including an evaluation by an anesthesiologist is performed.