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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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.