Surgical Procedures for Chronic Obstructive Pulmonary Disease (COPD)
by Alayne Ronnenberg, ScD
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 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 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)
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.
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.
COPD. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115557. Updated September 1, 2018. Accessed October 15, 2018.
Living with COPD. National Heart Lung and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/copd. Accessed October 15, 2018.
Patient Education: Teaching the Patient with Chronic Obstructive Pulmonary Disease (COPD). EBSCO Nursing Reference Center website. Available at:
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Updated March 28, 2018. Accessed October 15, 2018.
Last reviewed March 2018 by Michael Woods, MD, FAAP
Last Updated: 3/30/2018
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