Lung volume reduction surgery

Lung volume reduction refers to the surgical removal of a diseased or damaged part of lungs caused due to lung diseases such as emphysema. Damaged lungs are unable to function properly and may cause difficulty in breathing.

This surgery will improve your breathing ability by achieving these two outcomes:

• Reduction in the size of over-inflated lungs (excessive air is trapped in the lungs)
• Allowing expansion of the remaining non-diseased part of the lungs 

The surgeon will advise a lung reduction surgery if you have severe emphysema, usually in the upper portion of the lungs. Emphysema is a condition wherein the air sacs (alveoli) of the lungs are damaged. This condition usually occurs after years of smoking. The symptoms of emphysema are as follows: 

• Difficulty in breathing, especially while climbing steps or doing light exercises 
• Wheezing 
• Existing or continuous fatigue 
• A sensation of tightness in the chest
• Extended duration of cough  
• Constant feeling of an inability to breathe

The surgery also relieves disabling dyspnoea (difficulty in breathing) and air entrapment inside the lungs caused due to COPD.  

A surgeon may not perform this surgery if you have the following conditions:

• Mental disorders such as anxiety or depression 
• Less than 70% or more than 130% of ideal body weight
• Current or recent diagnosis of cancer 
• Any health issues that increase the risks of surgery 
• Using tobacco within the last six months 
• Old age (usually more than 70 years)

The following preparations are requied before this surgery:

• The healthcare practitioner will ask you to undergo the following tests to check the health of your lungs:
  • Cardiopulmonary exercise test (an exercise test using a treadmill or stationary bike to assess the function of lungs and heart)
  • Six-minute walk test (the distance walked by an individual in six minutes is measured to assess endurance)
  • Chest x-ray (to assess the organs in the chest)
  • Oxygen titration (determines the amount of oxygen used by an individual at rest and during exercise)
  • Arterial blood gas (to measure the oxygen and carbon dioxide levels in the blood)
  • Electrocardiogram (to measure and assess the electrical activity of the heart)
  • Pulmonary function test (to assess the lung function)
  • High-resolution computed tomography scan (to get a better view of internal organs for planning surgery).
• Additionally, you may also have to undergo a cardiac stress test and right heart catheterization to evaluate the function of your heart.
• You will be asked to fast from midnight before the surgery until you are permitted to eat or drink after surgery.
• You must inform your doctor about your current or previous medicines that you are taking. These include any over-the-counter medications, herbs, vitamins and supplements. 
• The doctor may ask you to stop certain medicines for better recovery. These include blood-thinners such as aspirin, warfarin, and vitamin E.
• You will need to arrange for someone, a friend or a family member, to take you home after the procedure. 
• You must stop smoking for up to six months before the surgery as smoking may delay healing.
• Make sure to carefully read the consent form (you will be ask to sign it to grant your approval for the procedure) before the surgery.

The surgery will include the following steps: 

• You will lie in a supine position (on your back) with your arms over your head.
• A healthcare practitioner will give you general anaesthesia - you will be asleep during the procedure.
• The surgeon will perform either sternotomy or thoracoscopy to expose your lungs. In sternotomy, the surgeon makes a large incision in the breastbone to open the chest area. Usually, both lungs are operated via this type of surgery.
• Thoracoscopy is done in the following way:
  • The surgeon will make three to five cuts on each side of your chest between your ribs.
  • Through one of these incisions, he/she will insert an instrument with a camera (videoscope) into your chest cavity. 
  • Thereafter, the surgeon will insert other surgical instruments through other incisions to perform the surgery.
• In either of the procedure, the surgeon will remove the diseased/affected part of your lungs.
• Once, the affected part is removed, a helathcare practitioner will place chest tubes inside your chest cavity to remove trapped fluid and air and allow your lungs to re-expand. 
• Finally, the surgeon will stitch up your chest with sutures.

This surgery takes about three to four hours to complete.

After the surgery, you will be shifted to the intensive care unit for careful monitoring of your vitals.

During your stay in the hospital, the following events can occur as per the need:

• A nurse will help you in getting out of the bed and walk for a small distance. 
• The chest tubes placed in your chest to drain air and fluid after the surgery will be removed once you regain your lung capacity and can breathe on your own.
• You will be given blood-thinning medicines to prevent the development of clots after the surgery. You will be asked to wear special stockings to prevent clotting in your legs. 
• You will have an intravenous line started in your arm or hand to administer medicines for pain. 
• You will be taught deep breathing exercises to help regain your lung capacity and prevent lung infections.

Once you are discharged to home, you will have to take the following care:

• Medicines and therapy: 
  • You will be given painkillers and other necessary medicines after surgery. 
  • A breathing device will be provided to you to use four to six times a day for at least two weeks after the surgery so that you slowly regain your lung capacity. 
• Wound care: 
  • Your doctor may suggest you to keep the wound area clean and dry and to change the dressing every day.
  • It is normal to feel numbness, soreness and swelling around the wound area for a while.
• Bathing or showering: 
  • You would be allowed to take a shower once the dressing is completely removed. 
  • Avoid soaking in the bathtub, hot tub or pool until your doctor allows you to. 
  • Also avoid scrubbing or soaking your wound for a long time. Instead, you can gently wipe it.
• Activities:
  • Your doctor may suggest you to avoid lifting heavy objects or exercising for a while after the surgery. 
  • Walking for at least two to three times a day is good for your recovery. However, initially, you must walk slowly for small distances only. 
  • Try to be slow while climbing the staircase. 
  • You may start doing light chores two weeks after surgery and resume your work four to eight weeks after the surgery.
• Travel:
  • You may be asked to avoid travelling via aeroplane for up to six weeks after surgery. 
  • The doctor will tell you when it is okay to resume driving after assessing your condition.

When to see the doctor?

You must call your doctor or visit the hospital immediately if you experience any of the following symptoms:

• Blood on coughing
• Fever of 101^°F (38.3^°C) or higher
• Trouble breathing 
• Swelling on the neck, face or chest 
• Pain even after taking medicines
• Difficulty in eating or drinking 
• Persistent cough with yellow- or green-coloured mucus
• Drainage from the wound area 
• Crack or hole in the chest tube 

The following risks/complications are associated with this surgery:

• Heart attack 
• Air leakage from lungs
• Excessive loss of blood
• Stroke 
• Infection 
• Unfavourable reaction to anaesthesia

You will need a follow-up appointment seven days after the procedure to get the stitches removed.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.