Chronic Obstructive Lung Disease - Surgical Procedures

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One year after surgery, lung transplant recipients have much better lung function, greater exercise capacity, and less breathlessness than LVRS patients. However, they are less likely to survive, and the transplant is far more expensive than LVRS.

Patients may not qualify for LVRS if they have:

• Chest wall deformity
• Dependence on corticosteroids
• Psychological problems
• Recent tobacco, drug, or alcohol dependence
• Scarring around the membrane of the lung
• Severe medical conditions that limit their lifespan

Other indicators of a poor outlook include severe lung complications and air pockets in diseased areas of the lungs (bullae).

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Specific Techniques. At this time, the preferred technique is surgery done on both lungs (bilateral lung volume reduction). Surgeons use either an open approach, making a large cut in the chest area, or video-assisted thoracoscopy (VATS), which is less invasive and involves several small cuts. Either method is effective and has similar complication rates. Lines of staples are typically used to reduce lung volume.

The alternative technique is surgery done on only one lung (unilateral lung volume reduction). Some centers believe this approach may cause fewer complications and the benefits last longer, although not all evidence supports its use over the bilateral method.

Bullectomy

Another option for COPD is bullectomy, in which giant air pockets and surrounding lung tissue are removed. It is generally limited to patients with giant bullae (not the typical COPD patient) and those with alpha-1 antitrypsin deficiency.

Review Date: 04/10/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).