Lung volume reduction surgery

It is usually a keyhole (VATS) operation and takes about one to two hours. During surgery you lie on your side with your arm raised. Up to four small cuts are made, each about 5cm (2in) long. These are used for the instruments and small camera to go into the chest. Special staples are used to cut and seal parts of lung that need to be removed. The piece of lung can be removed through one of the small cuts. The wound is closed with dissolvable stitches. One or Two chest drains are put in at the end of the operation and held in placed with a stitch. These remove any fluid or air from around the lung.

If a part of the operation cannot be done keyhole the operation may need to be changed to the open technique (thoracotomy). Open surgery is done with one longer cut under the shoulder blade between two ribs. The two ribs are parted to get into the chest. One rib may be cut to give more space, ribs are not removed. At the end of surgery the two ribs are held back together with strong stitches. The muscles and skin are also stitched back together.

Alternatively, a vertical cut about 15cm long may be made on the front of the chest (median sternotomy). This means the surgeon has to cut through the breastbone and it allows them to see both the left and the right lungs in the same operation. This is the same cut used to do heart bypass surgery.

It may take a few weeks for your lungs to fully adapt to the treatment. During the treatment recovery period, you may have some extra coughing, pain and breathlessness. This is normal and usually resolves within 30 to 90 days. The length of time you spend in hospital varies from person to person but usually be between four and 10 days. Some people will have a shorter stay and others longer, this is normal.

The risks here are a guide; your own risk may vary. You should discuss the risks and benefits of surgery with your surgeon, especially if you are worried. Since you will already have severe lung disease the risks are higher. A minitracheostomy may be recommended to help reduce the risk of a chest infection after surgery for this reason.

Minor more common risks 

Air leaking from the lung into the chest drain for a few days is common after lung surgery. Occasionally this lasts for longer, possibly weeks. A chest drain will need to be in place until this settles, you may be able to go home with the chest drain still in and come back for regular check-ups until the air leak settles. You may experience an exacerbation of your usual emphysema symptoms such as increased mucous secretions and wheezing. Your kidneys may not work as well after surgery but this is usually temporary and gets better with extra fluid.

Major less common risks

A flare up of breathing problems may be severe enough to require help from a ventilator machine. This can be via a face mask with you fully awake, known as non-invasive ventilation (NIV). It may also be need via a tube in the trachea with you under sedation. If you need help breathing via a tube in the trachea for a longer period it may be beneficial to have a temporary tracheostomy. Lung volume reduction surgery is a high risk operation. One in 20 die from the surgery and 19 in 20 recover from surgery. This should be weighed against the potential benefits in decided whether or not to proceed.