Lung Volume Reduction Surgery (LVRS)
Lung volume reduction surgery is a procedure
for people with advanced emphysema. During the
procedure, surgeons remove 20-30% of the most
diseased lung tissue. This allows the diaphragm
to return to a more normal position so it can
work effectively again. It also may improve lung
elasticity. After surgery, patients spend several
months regaining strength as their lungs heal.
How is LVRS Performed?
LVRS may be performed in one of two ways:
- median
sternotomy (a breastbone incision); or
- video
thoracoscopy (small incisions on the side
of the chest). A scope is placed in
one incision so the surgeon can see inside
the chest.
So far there is not enough evidence to prove
whether one method is more effective than the
other. If you are a candidate for LVRS, your
surgeon will evaluate which procedure will be
most beneficial for you. The average length of
stay in the hospital is 7-10 days.
While LVRS may lessen the effects of emphysema,
it is not a cure. Because it is a new procedure,
it is not yet clear how long the benefits will
last. Potential benefits may include improvement
in breathing, exercise tolerance and quality
of life, decreased dependence on oxygen, as well
as prolonged life.
Complications
LVRS is an elective procedure that carries
some risk, with a mortality rate of around 5%
overall. Reported complications include, but
are not limited to:
- pneumonia
- respiratory
failure that may require a period of time
on a ventilator
- prolonged air leak from the
lung
Because it is normal to have some air leakage
after surgery, a chest tube is placed in the
patient's chest to prevent the lung from collapsing.
As the lung heals, the air leaks seal. Most air
leaks heal within a week of surgery, although
some patients may have to remain in the hospital
for a longer period of time before the chest
tube can be removed.
For more information about LVRS, please call
either 1-800-789-PENN (7366) or the Emphysema
Program at 1-888-552-COPD.
Treatment
at Penn
At
Penn, lung volume reduction surgery may be performed
as part of the National Emphysema
Treatment Trial (NETT), a research study
for patients with severe emphysema. Selecting
patients for lung volume reduction surgery is
a four-step process:
Step 1: Referral
to emphysema program
Step 2: Medical
records review
Step 3: Insurance
clearance
Step 4: Evaluation
Step 1: Referral
to emphysema program
To be referred for lung volume reduction
surgery, you may call (or ask your physician
to call) the Emphysema Program. You may contact
us at 1-800-789-PENN (7366), or you
may call the Emphysema Program directly at 1-888-552-COPD.
We strongly encourage patients to discuss the
program with their doctors. Referrals will be
considered for patients who have advanced emphysema
and who have not smoked for at least four months
before referral to Penn.
Step 2: Medical
records review
Before we schedule an appointment for you,
please send us your medical records. This helps
us evaluate your condition to see if you are
a candidate for lung volume reduction surgery
and to determine what tests you need so that
we can make the most of your visit. (If the tests
we need have not been performed, please call
us before scheduling them. Many of these studies
must be performed in a specific manner).
We will need the following:
- Information about your medical history and
current condition (your doctor may write us
a letter).
- Most recent pulmonary function tests and
arterial blood gases.
- Pulmonary exercise test and/or 6-minute walk
test.
- Most recent chest X-ray and CT scans. (Reports
of these may be sent, but in certain cases
we may request the actual films or studies.)
- Echocardiogram, EKG and Dobutamine stress
thalium tests (if they have been performed).
- Ventilation perfusion scan (if one has been
performed).
Please forward medical records to:
The Emphysema Program
Hospital of the University of Pennsylvania
First Floor, Silverstein Building
3400 Spruce Street
Philadelphia, PA 19104
Step 3: Insurance
clearance
If you have Medicare, it will help pay the
costs of doctor's visits and tests. If you are
assigned to have lung volume reduction surgery,
Medicare also will help pay hospital costs. You
will need to pay the deductibles and any share
of the costs required by Medicare and any other
insurance you have.
If you do not have Medicare but have other insurance,
check with your insurance company. People with
private insurance may be able to have lung volume
reduction surgery outside of the NETT.
Step 4: Evaluation
If, after review of your medical records,
you are considered a candidate for lung volume
reduction surgery, we will schedule an outpatient
evaluation for you.
Locations
Hospital
of the University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104
Directions
Penn Presbyterian Medical Center
Philadelphia Heart Institute Building
Ground Floor
54 N. 39th Street
Philadelphia, PA 19104
Directions
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