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Surgical Procedures for Chronic Obstructive Pulmonary Disease (COPD)

Surgery may be used to treat a small number of people with COPD. It can improve symptoms, make breathing easier, and sometimes prolong life. However, it cannot cure the disease. Surgical procedures include:

Endobronchial Valve

Endobronchial valves are implantable devices that help reduce excess lung volume in people with advanced emphysema. The purpose of the one-way valve is to block air from getting into damaged lung tissue areas during inhalation. When exaling, the valve opens and allows air to exit along with mucus. Once the device is in place, the diseased portion of the lung collapses to achieve a reduction in lung volume. Endobronchial valves have been shown to improve lung function and exercise tolerance.

The valves are placed during a bronchoscopy. A tube is inserted through small incisions. The tube has a camera and allows the doctor to pass surgical instruments. It is possible to have more than one valve placed. The number of valves needed depends how much lung volume needs to be reduced. The procedure is less invasive than the lung volume reduction surgery described below.

Bullectomy

Bullectomy improves breathing for a small number of people with COPD. This is a rarely done elective procedure. It involves the surgical removal of a large air space, called a bulla, which is filled with oxygen-depleted air. When the bulla is removed, healthy functioning air sacs around it have room to expand. This makes muscles used for breathing work better. Usually only one large bulla is removed.

Surgeons do bullectomy in two different ways. An incision is made in the side of the chest wall between the ribs. This is called a thoracotomy. Then, a tube mounted with a small video camera, called a video thoracoscope, is inserted. Surgical instruments are also attached to the thoracoscope. The surgeon is able to view the lung on a video screen while removing the bulla. The bulla can also be removed through this incision.

Lung Volume Reduction Surgery (LVRS)    TOP

This procedure is done to relieve symptoms in people with advanced COPD. Surgeons remove a portion of the most diseased lung tissue. This allows the diaphragm to return to a more normal position, allowing it to work more efficiently. This may improve lung elasticity. In some people, surgery can improve symptoms.

Surgeons do LVRS with a thoracotomy. The surgeon removes the diseased lung tissue through a large incision. In another method, surgeons insert a video thoracoscope through a small incision. They remove diseased tissue while viewing the lungs on a video screen (VATS). In both procedures, surgeons remove about 20%-30% of the most damaged lung tissue.

Lung Transplant    TOP

A lung transplant is a surgical procedure to remove severely diseased lungs and replace them with healthy lungs from a human donor. One or both lungs may be transplanted. The procedure may be done in people with end-stage COPD.

In a single lung transplant, the surgeon makes an incision on your side, about 6 inches below your underarm. A horizontal incision across the lower chest is made for a double lung transplant. You will be put on a ventilator and a heart-lung machine. The heart-lung machine takes over the functions of the heart and lungs during the operation. A small section of rib is permanently removed to allow access to your lung. The old lung is cut away from the main blood vessel and bronchus. The new lung is then inserted. The blood vessels and bronchus are attached to the new lung. You will probably remain on medications indefinitely to prevent rejection of your transplanted organs.

References:

COPD. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115557/COPD. Updated February 9, 2017. Accessed February 22, 2017.
Ernst A, Anantham D. Bronchoscopic lung volume reduction. Pulm Med. 2011:1-6.
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2017. Global Initiative for Chronic Obstructive Lung Disease website. Available at:
...(Click grey area to select URL)
Accessed February 22, 2017.
Insertion of endobronchial valves for lung volume reduction. NICE—National Institute for Health and Care Excellence website. Available at: https://www.nice.org.uk/guidance/ipg465. Accessed February 22, 2017.
How is COPD treated? National Heart, Lung, and Blood Institute website. Available at:
...(Click grey area to select URL)
Updated July 31, 2013. Accessed February 22, 2017.
Jarad N. Clinical review: Endobronchial valve treatment for emphysema. Chron Respir Dis. 2016;13(2):173-178
Surgery. American Lung Association website. Available at:
...(Click grey area to select URL)
Updated November 30, 2016. Accessed February 22, 2017.
Last reviewed February 2017 by Michael Woods, MD, FAAP
Last Updated: 2/22/2017

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