Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume reduction (LVRS), unilateral includes any pleural procedure, when performed
CPT4 code
Name of the Procedure:
Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume reduction (LVRS), unilateral. Also known as Thoracoscopic Lung Volume Reduction Surgery (LVRS).
Summary
Thoracoscopic Lung Volume Reduction Surgery (LVRS) is a minimally invasive surgical procedure aimed at removing diseased portions of the lung in patients with severe emphysema. This surgery helps improve lung function and breathing capacity by reducing the volume of the diseased lung tissue.
Purpose
The primary purpose of LVRS is to alleviate symptoms of emphysema, including severe shortness of breath, and to enhance the overall quality of life for patients. The procedure aims to decrease lung hyperinflation, thus allowing the remaining healthier lung tissue to function more effectively.
Indications
- Severe emphysema not adequately controlled by medication or other treatments.
- Significant shortness of breath affecting daily activities.
- Hyperinflated lungs due to bullous or non-bullous emphysema.
- Candidates typically have a poor exercise capacity and impaired lung function tests.
Preparation
- Patients may be required to fast for a specific period before the surgery.
- Certain medications might need to be adjusted or paused.
- Pre-procedure diagnostic tests, including pulmonary function tests, imaging studies like CT scans, and complete blood work, are usually performed.
- Smoking cessation is highly recommended.
Procedure Description
- The patient is placed under general anesthesia.
- Small incisions are made in the chest to insert a thoracoscope (a small video camera) and surgical instruments.
- The surgeon visually examines the lung and identifies diseased tissue.
- Diseased portions of the lung are resected (removed) and plicated (folded and sutured) to reduce lung volume.
- Any necessary pleural procedures are performed concurrently.
- Chest drains may be placed to remove air and fluid, and the incisions are closed.
Duration
The procedure typically lasts between 2 to 3 hours, depending on the complexity of the case.
Setting
Thoracoscopic LVRS is usually performed in a hospital operating room or a specialized surgical center equipped for thoracic surgeries.
Personnel
- Thoracic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
- Respiratory therapist (if needed in post-operative care)
Risks and Complications
- Common risks include infection, bleeding, and air leaks.
- Rare but serious complications may include respiratory failure, heart problems, and prolonged air leaks.
- Management of complications might involve additional surgical or medical interventions.
Benefits
- Improved lung function and breathing capacity.
- Enhanced exercise tolerance and ability to perform daily activities.
- Reduction in the severity of emphysema symptoms.
- Most patients start to notice improvements within weeks to months post-surgery.
Recovery
- Post-operative stay in the hospital generally lasts about 7 to 10 days.
- Patients will have chest tubes initially to drain fluids and air.
- Pain management measures, including medications and breathing exercises.
- Full recovery and return to normal activities can take several weeks to months.
- Follow-up appointments are crucial for monitoring progress and lung function.
Alternatives
- Medical management with medications (bronchodilators, steroids).
- Pulmonary rehabilitation programs.
- Other surgical options like lung transplantation (in selected patients).
- Each alternative has its own risks and benefits compared to LVRS.
Patient Experience
- Patients can expect to experience some post-operative pain, managed with medications.
- Initial chest discomfort and breathing difficulties as the lungs adjust.
- Gradual improvement in breathing and activity levels.
- Continuous support and education on breathing techniques and lifestyle modifications.