Advancements in Lung Volume Reduction Surgery Explored by Dr. Bakhos

At the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD Conference in Philadelphia, Dr. Charles Bakhos, a professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, discussed the critical role of lung volume reduction surgery (LVRS) for patients suffering from severe emphysema and respiratory failure. These individuals often face a cycle of frequent COPD exacerbations, leading to significant oxygen dependence.

Dr. Bakhos emphasized that patients who typically require LVRS have exhausted most treatment options for improving their quality of life and survival rates. “On average, they have few options for quality-of-life improvements and improving their survival rate — so that’s where we come with the principle of the intervention, in trying to remove unhealthy lung tissue or get it out of the equation,” he stated. The goal of LVRS is to create more space for healthier lung tissue, potentially allowing patients to discontinue oxygen use, enhance their quality of life, and regain the ability to perform daily activities.

Overcoming Historical Challenges

A significant barrier to initiating LVRS is the historical stigma surrounding the procedure, which has evolved greatly since its inception in the 1950s. Early surgical approaches were associated with high rates of complications and mortality, largely due to the limitations of medical technology at that time. Dr. Bakhos pointed out that LVRS was revitalized in the 1990s, supported by a randomized trial that demonstrated its benefits for a specific subset of patients. “It showed its benefit in a particular group of patients: those who have their emphysema, mostly in the upper lung zone area, and those who are, I would say sick enough — but not too sick and not healthy enough, because you would want the risk-benefit ratio to work to your advantage and their advantage,” he explained.

Candidates for LVRS at Dr. Bakhos’ clinic must undergo rigorous screening processes, which include imaging and pulmonary physiologic testing. A crucial requirement for eligibility is the commitment to participate in pulmonary rehabilitation both before and after the surgery. “It gives us an idea about their compliance and whether they can stick to a program where they are basically assigned to go to rehab once, twice, or three times a week,” he noted. Engaging in rehabilitation not only enhances patients’ stamina but also improves their energy levels and overall conditioning prior to the surgery, which is often riskier than standard procedures.

Emphasizing Collaborative Care

For healthcare professionals aiming to refine LVRS practices, Dr. Bakhos advocated for a multi-disciplinary approach. He highlighted the collaborative structure of his team at Temple, which ensures that patients do not leave the same floor as their pulmonologist during the surgical referral process. “I would strongly focus on the collaborative efforts between pulmonary and thoracic,” he stated.

In addition to working closely with pulmonologists, the team collaborates with radiologists to take advantage of advanced imaging technologies. These tools assist in the precise selection of patients and help target the most affected areas of the lung during surgery. Dr. Bakhos remarked, “We have advanced imaging technology now that we’re able to use that does help us with patient selection for surgery and even in the operating room, it does help us quite a bit in targeting the most emphysematous area of the lung and go after it in order to get the best outcomes possible.”

Through these advancements and collaborative efforts, the future of lung volume reduction surgery looks promising for patients seeking relief from the debilitating effects of COPD.