Surgical Procedures for Chronic Obstructive Pulmonary Disease (COPD)
Surgery may be used to treat a small number of people with COPD. Although it can improve symptoms, make breathing easier, and sometimes prolong life, it does not provide a cure for the disease.
Although not a cure for COPD, bullectomy does improve breathing for a small number of COPD patients. This is rarely-performed elective procedure that 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, and muscles used for breathing work better. Usually only one large bulla is removed, whereas lung volume reduction surgery (see below) involves removal of a piece of lung containing many nonfunctioning air sacs.
Surgeons perform bullectomy in two different ways. In one method, a small incision is made in the side of the chest and a tube mounted with a small video camera, called a video thoracoscope, is inserted. Surgical instruments are also attached to the thoracoscope, and the surgeon is able to view the lung on a video screen while removing the bulla. Alternatively, the surgeon may make a 4- to 6-inch incision in the chest, usually beneath the armpit, and the bulla is removed through the incision.
Lung Volume Reduction Surgery (LVRS)
This procedure is performed to relieve symptoms in patients with advanced COPD; it is not a cure for COPD. Surgeons remove a portion of the most diseased lung tissue. This allows the diaphragm to return to a more normal position so that it works more effectively. This may improve lung elasticity. When emphysema involves primarily the upper lobes of the lung, LVRS may somewhat prolong life. In properly selected patients, surgery can improve symptoms.
Surgeons perform LVRS in two different ways. In one method, an incision is made through the breastbone, and the surgeon removes the diseased lung tissue through this incision. In the other method, surgeons insert a video thoracoscope through a small incision in the side of the chest. They remove diseased tissue while viewing the lungs on a video screen. In both procedures, surgeons remove about 20%-30% of the most damaged lung tissue.
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 is performed in patients with end-stage COPD as well as in those with a genetic alpha-1-antitrypsin deficiency.
In a single lung transplant, the surgeon makes an incision on your side, about six 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 (artificial breathing machine) 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 (large airway), and the new lung is inserted. The blood vessels and bronchus are attached to the new lung. Anesthesia prevents pain during the procedure. You'll likely experience pain while recovering but receive drugs to relieve the discomfort. You will probably remain on medicines indefinitely to prevent rejection of your transplanted organs.
When to Contact Your Doctor
Some pain and discomfort are normal after surgery. Remember that you are more susceptible to infections while you are taking immunosuppressive medications (drugs to prevent rejection of transplanted organs). Be sure to contact your doctor if you experience any of the following:
- Signs of infection, including fever or chills
- Redness, swelling, increasing pain, or discharge at the incision site
- Increased coughing, shortness of breath, chest pain, or severe nausea or vomiting
- Increased phlegm production or coughing up blood
- The surgical wound opens
- Extreme changes in weight
- New chest pain
- Urinary pain, burning, or urgency; frequent urination or persistent blood loss in your urine (because of a urinary catheter which was inserted during surgery)
American Lung Association website. Available at: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22542 .
Current Surgical Diagnosis and Treatment . McGraw-Hill; 2002.
National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .
Last reviewed June 2008 by
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