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.
Bullectomy improves breathing for a small number of COPD patients. 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. Lung volume reduction surgery (see below) involves removal of a piece of lung containing many nonfunctioning air sacs.
Surgeons do bullectomy in two different ways. In one method, a small incision is made in the side of the chest. 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. Alternatively, the surgeon may make a 4- to 6-inch incision in the chest, usually beneath the armpit. The bulla can also be removed through this incision.
This procedure is done 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. That allows it to work more effectively. This may improve lung elasticity.
In properly selected patients, surgery can improve symptoms.
Surgeons do LVRS in two different ways. In one method, an incision is made through the breastbone. 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. Lung volume reduction surgery can also be done by an interventional pulmonologist with the help of a bronchoscope.
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 patients with end-stage COPD.
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, which is an 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 . The new lung is then 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.
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http://www.nhlbi.nih.gov/health/health-topics/topics/copd. Updated June 8, 2012. Accessed March 29, 2013.
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http://www.goldcopd.org/uploads/users/files/GOLD_Patient_RevJan10.pdf. Accessed March 29, 2013.
Last reviewed June 2013 by Brian Randall, MD
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