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Lung Volume Reduction Surgery (LVRS)

This type of surgery for Lung Volume Reduction Surgery(LVRS) was first used to treat emphysema in 1950s. It was not widely practised, because of the uncertainty surrounding its long-term benefits, and high-risk mortality. This surgery is now used to help treat people with severe disabling emphysema.

LVRS is used most effectively is US in the division of Thoracic Surgery. LVRS is used to remove 20-30% of the damaged lung so that the remaining tissue and surrounding muscles are able to work more efficiently, making breathing easier.

Risk Factors

  • There are risks involved with lung reduction surgery, and it is high at risk, as the candidates for this type of surgery are usually older in age.
  • As this is one of the high risk procedures, the death rate is approximately 6-10 % nationwide.

Surgical Techniques

Thoracoscopy (Unilateral or Bilateral)

This surgical procedure is a minimally invasive technique. Three incisions about 1 inch are made in each side,between the ribs. A video-scope is placed through one of the incisions. The scope helps the surgeon to see the lungs. A Stapler and grasper are inserted in the other incisions, these are used to remove parts of the lungs which are damaged. The stapler will reseal the remaining lung. The surgeon then sutures which will eventually dissolve to close the incisions. This technique can be used to operate on either one or both lungs which allows the assessment and resection of any part of the lungs.

Thoracotomy (Unilateral or One-Sided)

This procedure, an incision is made between the ribs. The incision is made approximately 5-12 inches long. The ribs are then separated, not broken, and the lungs are seen. Only one lung is reduced with this procedure. The muscle and skin are closed by sutures. This procedure is often used when the surgeon is not able to see the lung clearly through the thoracoscope or when dense scar tissues are found(known as adhesions).

Complications

  • Air leakage - This air leakage occurs when air leaks from the lung tissue, coming from the suture line, into the chest cavity. If the air volume becomes too much, with pressure the lung can collapse. One or more chest tubes are placed during surgery to monitor the air leakage and prevent the collapse of the lung tissue. This is a common complication in over 50% of patients.
  • Bleeding (2-5%)
  • Heart attack (1%)
  • Death that results from a worsening of one of the above complications (6-10%)
  • Pneumonia (19%) or infection (1-5%) is common in emphysema patients, especially when they have a history of these conditions.
  • Stroke (less than 1%)

The Hospital Experience

Patients are expected to stay about 5-10 days, on the "CARDIOGTHORACIC SURGICAL CARE UNIT". Most patients stay in the intensive care unit (ICU) for around about 2 days, except to recover as soon as possible, within hours of surgery.

Pulmonary Rehabilitation

Pulmonary Rehabilitation, starts on the first post-operative day. Exercise and training is important for your recovery. The more you exercise, and move around, the quicker and less painful your recovery will be. It also depends solely on the patient , to recover faster. You may feel a bit weak, however you need to listen to the therapists and nurses, as exercise is the key to recovery. Your exercise will be of walking in the corridor, on the treadmill or on the bicycle everyday.

The patient undergoes,extensive pulmonary rehabilitation, during pre-operative process. This process will need to be continued until the time of surgery, as well as during the post-operative period, which includes the initial days after surgery. It is very important to cough and breathe deeply after surgery, as your lungs need to fully expand to prevent infection and collapse. Deep breathing , coughing, and incentive spirometry are most effective means of achieving this goal. It is also important that you practice deep breathing and coughing even before surgery.

  • Deep Breathing : On the count of five(5) fill your lungs up slowly hold for a count of five (5) and then exhale slowly over the count of (5).

    REPEAT 10 TIMES per hour while you are awake.

  • Coughing :Take (3)slow breaths, filling your lungs up as much as possible. Initiate to cough on the second breath exhale. Make sure that you hold your incision(splint) during the cough.

    REPEAT 10 TIMES per hour while you are awake.

  • Incentive Spriometer : This spriometer helps with your breathing exercise on the day of surgery. Hold the spirometer securely with both your hands, Place your mouth on the mouthpiece and exhale around the mouthpiece, and make a tight seal on the mouthpiece and inhale slowly to the count of five(%)-watch the disc move upward. Hold your breathe on the count of (5) and loosen the seal around the mouthpiece and exhale.

    REPEAT 10 TIMES per hour while you are awake.