What is Emphysema? Surgery and Treatment

Ingredients

What is Emphysema? Increased Lung Volume and Shortness of Breath
What is Emphysema Surgery (Volume Reduction Surgery)?
Who is Emphysema Surgery Applied to? Patient Selection Criteria
Advanced COPD and Emphysema Patients
Conditions That Prevent Surgery (Contraindications)
Emphysema Surgery Methods
Surgical Volume Reduction (LVRS)
Bronchoscopic Volume Reduction (Valve and Smart Wire Applications)
Bullectomy (Removal of Large Air Sacs)
Preoperative Preparation and Evaluation Process
Lung Function Tests (PFT) and Diffusion Capacity
Computed Tomography and Scintigraphy Examinations
How is Closed Emphysema Surgery (VATS) Performed?
Advantages of Emphysema Surgery and Expected Outcomes
Increase in Effort Capacity and Quality of Life
Reduced Drug and Oxygen Dependency
Postoperative Recovery and Pulmonary Rehabilitation
Frequently Asked Questions
Is Emphysema Surgery a Risky Surgery?
Is Volume Reduction Performed in Patients with Lung Collapse (Pneumothorax)?
Will I Recover Completely After Surgery?

Emphysema is one of the most advanced and destructive forms of chronic obstructive pulmonary disease (COPD).

In this disease, the air sacs (alveoli) in the lungs are permanently damaged and lose their flexibility.

When the walls of the air sacs break down, the lungs have difficulty expelling the air inside and begin to swell excessively inside the rib cage.

This condition is a serious mechanical problem that causes healthy lung tissue to compress and the diaphragm muscle to flatten and become inefficient.

Emphysema surgery, or “Lung Volume Reduction Surgery” as it is medically known, is an advanced treatment method that aims to eliminate this mechanical barrier.

What is Emphysema? Increased Lung Volume and Shortness of Breath

Emphysema is more than a simple shortness of breath, it is the deterioration of the architectural structure of the lung.

Air trapped in damaged and expanding air sacs creates what we call “air trapping”.

Since the lungs take up much more space than they should, the rib cage expands and the patient has a “barrel chest” appearance.

The biggest problem is that these over-swollen but dysfunctional areas leave no room for the still healthy lung tissue to breathe.

With each inhalation, the patient feels a deep “air hunger” because he cannot inflate his lungs any more.

In this process, the diaphragm muscle is pushed downward and loses its normal arch, dramatically increasing the respiratory workload.

What is Emphysema Surgery (Volume Reduction Surgery)?

Emphysema surgery is the process of removing or disabling the most damaged and no longer functioning parts of the lung.

The question “Why do we remove some of the lungs when they are already insufficient?” is frequently asked by patients.

The basic logic here is to remove the tissue that is useless and only occupies space, and to ensure that the stuck healthy tissue expands again.

When the volume decreases, the diaphragm muscle returns to its normal dome shape and the chest wall begins to move more efficiently.

This procedure restores the mechanical efficiency of the lung, allowing the patient to breathe more easily.

Who is Emphysema Surgery Applied to? Patient Selection Criteria

Not every emphysema patient is a suitable candidate for surgical intervention.

The success of this procedure depends on the patient undergoing a very rigorous pre-evaluation process.

Before the decision for surgery is made, the patient’s medical history, radiological findings and respiratory capacity are analyzed in detail.

Advanced COPD and Emphysema Patients

The surgical option is usually considered for patients who still have severe shortness of breath despite receiving maximum medication and pulmonary rehabilitation.

Heterogeneous Emphysema: Patients in whom lung damage is not evenly distributed throughout the lung and certain areas (usually the upper lobes) are more damaged are the most suitable candidates.
Air Trap: A lung volume that is too high than normal (hyperinflation) must be proven by technical tests.
Smoking: The main condition is that the patient has completely quit smoking at least 4-6 months before the surgery.
Effort Capacity: The patient’s limited walking and movement capacity is critical for the healing process.

Conditions That Prevent Surgery (Contraindications)

In some cases, surgical risks far exceed the expected benefit.

The success of surgery is lower in cases where lung damage is evenly distributed (homogeneous).

Severe heart failure, extremely low diffusion capacity (DLCO < 20%) or very high pulmonary blood pressure (pulmonary hypertension) are obstacles to surgery.

In addition, the presence of active cancer or very advanced age (usually over 75-80) are factors affecting the surgical decision.

Emphysema Surgery Methods

In modern medicine, volume reduction procedures can be applied with different techniques depending on the patient’s condition.

Which method to choose is determined by the distribution of emphysema in the lung and the patient’s capacity to handle surgery.

Surgical Volume Reduction (LVRS)

It is a classic volume reduction surgery and is usually performed with the closed method (VATS).

Dysfunctional and excessively swollen tissues located in the upper parts of the lung are cut and removed with special suture tools (staplers).

This method is considered the “gold standard” because it completely removes problematic tissue from the body.

Bronchoscopic Volume Reduction (Valve and Smart Wire Applications)

It is an interventional alternative for patients who are too weak to handle surgery or do not want surgery.

One-way valves are inserted into the airway leading to the damaged lobe of the lung with a camera (bronchoscope) entered through the mouth.

These valves prevent air from entering while allowing it to exit through that lobe; Thus, that area deflates over time and volume reduction is achieved.

In the “smart wire” (coil) method, the wires placed in the airways shrink the tissue and reduce the volume.

Bullectomy (Removal of Large Air Sacs)

Sometimes emphysema forms giant air sacs in one area of the lung, larger than 1 cm in diameter, called “bullae”.

These large sacs can sometimes grow large enough to cover half of the entire lung, completely crushing the intact tissue.

In the bullectomy procedure, only these giant sacs are removed; This procedure usually provides immediate and dramatic relief.

Prof. Dr. Levent Alpay: The most critical point in emphysema surgery is “timing” and “choosing the right patient”. No matter how successful the surgery is, if the patient continues to smoke or does not comply with the postoperative rehabilitation program, the gains may be lost in a short time. This is not a “miracle cure”, but a “reconstruction” procedure that corrects the mechanics of the lung.

Preoperative Preparation and Evaluation Process

Before emphysema surgery, the patient’s “functional reserve” is examined in detail.

This process is essential to identify patients who will benefit from surgery to the maximum extent and have the lowest risk of surgery.

The preparation phase usually takes a few weeks and results in a multidisciplinary council decision.

Lung Function Tests (PFT) and Diffusion Capacity

Pulmonary Function Tests (PFT) measure how much air the lung can hold and how quickly it can exhale that air.

In emphysema patients, the “forced expiratory volume” (FEV1) value is usually quite low.

Diffusion capacity (DLCO), on the other hand, indicates the lung’s ability to carry oxygen from the air into the bloodstream; If this value is not below a certain threshold, it is critical for surgical safety.

Computed Tomography and Scintigraphy Examinations

High-resolution Computed Tomography (CT) visualizes the distribution of emphysema within the lung (is it upper lobe-focused or diffuse?).

Lung perfusion scintigraphy, on the other hand, determines which areas of the lung receive blood and creates a complete map of the “dead zones” to be surgically removed.

Thanks to this mapping, healthy tissues are preserved, while only dysfunctional tissues are targeted.

How is Closed Emphysema Surgery (VATS) Performed?

Today, emphysema surgery is largely performed with a closed method called Video-Assisted Thoracoscopic Surgery (VATS).

In this method, the rib cage is not opened; Instead, the chest cavity is entered through two or three small incisions (about 1-2 cm) with a camera and special surgical instruments.

The surgeon cuts out the diseased areas predetermined in scintigraphy and CT with special “stapler” devices, accompanied by a high-resolution image taken from the screen.

The biggest advantage of the closed method is that it minimizes the postoperative pain of the patient, who is already suffering from respiratory distress, and allows him to stand up faster.

Advantages of Emphysema Surgery and Expected Outcomes

The basic philosophy of the surgery is not to heal the lung, but to allow the remaining healthy parts of the lung to work more efficiently.

Increase in Effort Capacity and Quality of Life

With the improvement of lung mechanics after volume reduction, significant increases are observed in the walking distances of the patients.

Patients who were previously out of breath even at home become able to perform daily self-care activities much more easily after surgery.

Reduced Drug and Oxygen Dependency

Partially restoring the natural flexibility of the lungs reduces the need for sprinkler-type drugs that reduce peanut stenosis.

In many cases, patients who are constantly dependent on an oxygen cylinder before surgery may be sufficient to receive oxygen support only during exertion after surgery.

Emphysema Treatment Methods and Expected Recovery Processes

Treatment Method	Technical Detail	Recovery Time	Success Focus
Surgery (VATS)	Removal of damaged tissue	3 – 5 days hospital	Long-term relief
Bronchoscopic Valve	Installing a valve in the airway	1 – 2 days hospital	Patients at risk of surgery
Bullectomy	Removal of the giant air sac	2 – 4 days hospital	Acute shortness of breath solution

Postoperative Recovery and Pulmonary Rehabilitation

If 50% of the success of the surgery is surgery, the other 50% is postoperative rehabilitation.

Patients are walked by standing up the day after the surgery and special breathing exercises are started.

A pulmonary rehabilitation program is a training process that teaches the patient to use the new lung volume in the most efficient way.

Prof. Dr. Levent Alpay: The most common mistake our patients make after volume reduction surgery is to stop exercising by saying “I’m healed anyway”. The lung is a muscle; If not operated, it tends to return to its old bulky structure. For this reason, regular walking and breathing exercises after the operation should continue throughout life.

Case Experience (Anonymous):

In a 65-year-old patient diagnosed with severe COPD and dependent on oxygen for 24 hours, intense air trapping was detected in the upper lobes as a result of scintigraphic examination. Bilateral volume reduction surgery was performed with the closed method (VATS). In the 2nd month after surgery, the patient reached a level where he could take short walks outside the home without oxygen support during the day, and a 60% improvement was recorded in the quality of life scales.

For more detailed information about emphysema treatment and volume-reducing surgery options, you can seek an expert opinion and make an appointment with our clinic.

Frequently Asked Questions

Is Emphysema Surgery a Risky Surgery?

Like any major surgical procedure, it has risks; however, thanks to the developing anesthesia techniques and the closed (VATS) method, vital risks are minimized in correctly selected patients.

Is Volume Reduction Performed in Patients with Lung Collapse (Pneumothorax)?

Yes, lung collapse, which is common in emphysema patients, is sometimes treated in the same session as volume reduction surgery. Thus, both the risk of deflation is eliminated and breathing capacity is increased.

Will I Recover Completely After Surgery?

Emphysema is an irreversible tissue damage; For this reason, instead of “complete recovery”, a significant increase in respiratory comfort and an increase in quality of life are aimed.

Scientific Bibliography