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department of Medicine

Section of pulmonary and critical care medicine

Programs and Services - Lung Volume Reduction Surgery

 

What Is Lung Volume Reduction Surgery (LVRS)?

 

Badly damaged portions of the lung with emphysema cannot be repaired. Once destroyed, the air sacs do not grow back. However, the less damaged parts of the lung can be helped to work better by removing the badly damaged areas.

 

In LVRS, the parts of the lung most damaged by disease are removed. Usually, about 20% to 35% of each lung is taken out. This “volume reduction” allows the remaining lung to fill and empty more completely with each breath.

 

Also, the diaphragm muscle returns to normal shape, working freely and more efficiently. As a result, patients can breathe more deeply and get more oxygen.

 

The surgery itself can be open chest (median sternotomy, like heart surgery) or less invasive (video assisted thoracic surgery). Surgeons use a variety of methods and materials (like lasers, staples and fabric) to remove the upper lobes and to seal the remaining lung tissue.

 

What Types of Patients Benefit from LVRS?

 

Not all emphysema patients would feel better after LVRS. A large emphysema study, called the National Emphysema Treatment Trial (NETT) that compared LVRS with standard drug and oxygen therapy, showed that LVRS clearly helps people with severe emphysema in the upper lobes of the lung who are not at high risk for surgery. But high-risk patients and those with lower lobe or widespread emphysema did not benefit—and sometimes were actually harmed.

 

Results of the National Emphysema Treatment Trial published in the May 2003 New England Journal of Medicine* showed that patients whose emphysema was predominantly in the upper lobes of the lungs and whose exercise capacity was low after pulmonary rehabilitation but prior to surgery, were more likely to survive longer and function better after LVRS compared to similar patients who received medical therapy only.

 

The Decision Summary on LVRS issued by the Centers for Medicare & Medicaid Services states that LVRS is reasonable and necessary:

 

  • For non-high-risk patients who satisfy the inclusion and exclusion criteria outlined in the NETT protocol and who present with severe upper lobe emphysema.
  • For non-high-risk patients who satisfy the inclusion and exclusion criteria outlined in the NETT protocol and who present with severe non-upper lobe emphysema with low exercise capacity.
  • Only if preceded and followed by a program of diagnostic and therapeutic services consistent with those provided in the NETT and designed to maximize the patient’s potential to successfully undergo and recover from surgery.
  • When performed at facilities that were identified by the National Heart, Lung, and Blood Institute (NHLBI) as participants in the NETT study and at sites that have been approved by Medicare as lung transplant facilities.

*New England Journal of Medicine. 2003;348:2059-2073.

 

Health Insurance Coverage


Medicare covers two LVRS procedures for appropriate patients: bilateral excision of damaged lung with stapling performed via median sternotomy or video-assisted thoracopscopic surgery.

 

Private insurers and state Medicaid programs often follow Medicare's lead
on coverage.