Lung volume reduction surgery for advanced emphysema

NICE interventional procedures guidance [IPG114] Published date:

Register an interest in this interventional procedure

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on lung volume reduction surgery for advanced emphysema.

  • Description

    Emphysema is a chronic lung disease, whereby walls of the air sacs (alveoli) in the lung weaken and disintegrate, leaving behind abnormally large air spaces that remain filled with air even when the patient breathes out. The most common symptoms of emphysema are shortness of breath (dyspnoea), coughing, fatigue and weight loss. Emphysema often coexists with chronic obstructive pulmonary disease (COPD).

    Treatment involves a multidisciplinary approach, which includes education, exercise, breathing retraining, smoking cessation, oral and inhaled medications, oxygen therapy, and lung transplantation. Lung volume reduction surgery may be an option for patients who experience breathlessness, and have pulmonary function tests that show severe obstruction and enlarged lungs.

    Lung volume reduction surgery (LVRS) aims to remove the least functional part of the lungs in order to improve airflow, diaphragm and chest wall mechanics and alveolar gas exchange in the remaining portion of the lung. The diseased part of the lung can be accessed by various techniques including median sternotomy, video assisted thoracoscopy (VATS) for unilateral or bilateral surgery, or thoracotomy (unilateral surgery). Median sternotomy involves cutting through the sternum to open the chest. The video assisted procedure involves making a number of small incisions in both sides of the chest to allow the insertion of instruments into the chest between the ribs.

    Surgery aims to reduce the volume of each lung by between 20 and 30%. This is done by using a surgical stapling device to cut and seal the tissue, laser ablation to shrink lung volume or a combination of both. Once the tissue has been removed the lung is re-inflated and the chest closed.

  • OPCS4.6 Code(s)

    E54.6 Reduction of lung volume

    In addition, either Y49.1 Median sternotomy approach or Y74.4 Thoracoscopic video-assisted approach to thoracic cavity would be assigned, dependent on the approach used.

    In addition a code from the ICD-10 category J43.- Emphysema would be recorded.

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.


  • Get involved