Skip to main content
SpringerLink
Log in

Uniportal Bullectomy for Emphysematous Bullous Lung Disease

  • Chapter
  • First Online:
Atlas of Uniportal Video Assisted Thoracic Surgery

  • 752 Accesses

Abstract

Bullous disease can occur alone or in conjunction with lung emphysema. Bullae vary in size and the term “giant bulla” is used when lesions exceed one-third of the hemithorax. Giant bullae may impair lung function and cause respiratory symptoms—mainly dyspnea and low exercise tolerance—negatively impacting patient’s quality of life. Bullous disease can lead to complications such as pneumothorax, infection and bleeding. Therefore, surgical treatment of bullous disease through bullectomy is indicated when complications occur or when giant bulla are associated to respiratory symptoms. An increasing giant bulla can also be considered for surgical resection, even when asymptomatic. The surgical aim is to remove the giant bullae, allowing expansion of the remaining lung, in order to restore respiratory function. Patients with large bullae and normal underlying lungs are those who accomplish the best results, but surgery should not be denied to emphysematous patients until a preoperative assessment is made to properly outline risks/benefits.

Uniportal video-assisted thoracic surgery is a feasible and safe method to perform bullectomy, with results at least comparable to other techniques, leading to symptoms resolution, improved lung function and better quality of life. This chapter will focus on this approach and its technical details.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Knudson RJ, Gaensler EA. Surgery for emphysema. Ann Thorac Surg. 1965;1(3):332–62.

    Article  CAS  Google Scholar 

  2. Meyers BF, Patterson GA. Chronic obstructive pulmonary disease. 10: Bullectomy, lung volume reduction surgery, and transplantation for patients with chronic obstructive pulmonary disease. Thorax. 2003;58(7):634–8.

    Article  CAS  Google Scholar 

  3. Deslauriers J. History of surgery for emphysema. Semin Thorac Cardiovasc Surg. 1996;8(1):43–51.

    CAS  PubMed  Google Scholar 

  4. Cooper JD. The history of surgical procedures for emphysema. Ann Thorac Surg. 1997;63(2):312–9.

    Article  CAS  Google Scholar 

  5. Klingman RR, Angelillo VA, DeMeester TR. Cystic and bullous lung disease. Ann Thorac Surg. 1991;53(3):576–80.

    Article  Google Scholar 

  6. Morgan MD, Edwards CW, Morris J, et al. Origin and behaviour of emphysematous bullae. Thorax. 1989;44(7):533–8.

    Article  CAS  Google Scholar 

  7. Ting KY, Klopstock R, Lyons HA. Mechanical properties of pulmonary cysts and bullae. Am Rev Respir Dis. 1963;87:538–44.

    Article  CAS  Google Scholar 

  8. Krishnamohan P, Shen R, Wigle DA, et al. Bullectomy for symptomatic or complicated giant lung bullae. Ann Thorac Surg. 2014;97:425–31.

    Article  Google Scholar 

  9. Lee KH, Cho SJ, Ryu SM, et al. Fluid-filled giant bulla treated with percutaneous drainage and talc sclerotherapy: a modified Brompton technique. Korean J Thorac Cardiovasc Surg. 2012;45:134–7.

    Article  Google Scholar 

  10. Taniguchi Y, Fujioka S, Adachi Y, et al. Video-assisted thoracoscopic bullectomy for an infectious giant bulla with the concomitant use of the perioperative intracavity fluid suction. J Thorac Cardiovasc Surg. 2009;137:249–51.

    Article  Google Scholar 

  11. Potapenkov MA, Shipulin PP. Surgical treatment of complicated bullous pulmonary emphysema. Grud Serdechnososudistaia Khir. 1993;4:39–42.

    Google Scholar 

  12. Hirai S, Hamanaka Y, Mitsui N, et al. Primary lung cancer arising from the wall of a giant bulla. Ann Thorac Cardiovasc Surg. 2005;11:109–13.

    PubMed  Google Scholar 

  13. Venuta F, Rendina EA, Pescarmona EO, et al. Occult lung cancer in patients with bullous emphysema. Thorax. 1997;52:289–90.

    Article  CAS  Google Scholar 

  14. Shanthaveerappa HN, Mathai MG, Byrd RP Jr, et al. Spontaneous resolution of a giant pulmonary bulla. J Ky Med Assoc. 2001;99:533–6.

    CAS  PubMed  Google Scholar 

  15. Scarlata S, Cesari M, Caridi I, et al. Spontaneous resolution of a giant pulmonary bulla in an older woman: role of functional assessment. Respiration. 2011;81:59–62.

    Article  Google Scholar 

  16. Palla A, Desideri MT, Rossi G, et al. Elective surgery for giant bullous emphysema – a 5-year clinical and functional follow-up. Chest. 2005;128:2043–50.

    Article  Google Scholar 

  17. Pearson MG, Ogilvie C. Surgical treatment of emphysematous bullae: late outcome. Thorax. 1983;38:134–7.

    Article  CAS  Google Scholar 

  18. Greenberg JA, Singhal S, Kaiser LR. Giant bullous lung disease: evaluation, selection, techniques, and outcomes. Chest Surg Clin N Am. 2003;13:631–49.

    Article  Google Scholar 

  19. De Giacomo T, Venuta F, Rendina EA, et al. Video-assisted thoracoscopic treatment of giant bullae associated with emphysema. Eur J Thorac Surg. 1999;12:753–7.

    Article  Google Scholar 

  20. Kayawake H, Chen F, Date H. Surgical resection of a giant emphysematous bulla occupying the entire hemithorax. Eur J Cardiothorac Surg. 2013;43:e136–8.

    Article  Google Scholar 

  21. Schipper PH, Meyers BF. Surgery for bullous disease. In: Person FG, Patterson GA, Cooper JD, editors. Thoracic & esophageal surgery. Philadelphia: Churchill Livingstone Elsevier; 2008. p. 631–52.

    Chapter  Google Scholar 

  22. Ng CSH, Yim AP. Video-assisted thoracoscopic surgery (VATS) bullectomy for emphysematous bullous lung disease. Multimed Man Cardiothorac Surg. 2005;2005(425):mmcts.2004.000265. https://doi.org/10.1510/mmcts.2004.000265.

    Article  PubMed  Google Scholar 

  23. Van Bael K, La Meir M, Vanoverbeke H. Video-assisted thoracoscopic resection of a giant bulla in vanishing lung syndrome: a case report and short literature review. J Cardiothorac Surg. 2014;9:4.

    Article  Google Scholar 

  24. Monaldi V. Endocavitary aspiration: its practical applications. Tubercle. 1947;28:223–8.

    Article  CAS  Google Scholar 

  25. Shah SS, Goldstraw P. Surgical treatment of bullous emphysema: experience with the Brompton technique. Ann Thorac Surg. 1994;58:1452–6.

    Article  CAS  Google Scholar 

  26. Santini M, Fiorelli A, Vicidomini G, et al. Endobronchial treatment of giant emphysematous bullae with one-way valves: a new approach for surgically unfit patients. Eur J Cardiothorac Surg. 2011;40:1425–31.

    Article  Google Scholar 

  27. Gonzalez-Rivas D, Bonome C, Fiera E, et al. Non-intubated video-assisted thoracic surgery: the future of thoracic surgery? Eur J Cardiothorac Surg. 2016;50:925–6.

    Article  Google Scholar 

  28. Ng CSH, Ho JYK, Zhao Z-R. Spontaneous ventilation anaesthesia: the perfect match for thoracoscopic bullectomy? Eur J Cardiothorac Surg. 2016;50:933.

    Article  Google Scholar 

  29. Mazzella A, Izzo A, Amore D, et al. Ann Ital Chir. 2016;87(ePub pii):S2239253X16024816.

    PubMed  Google Scholar 

  30. Sagawa M, Maeda T, Yoshimitsu Y, et al. Saline-cooled radiofrequency coagulation during thoracoscopic surgery for giant bulla. Eur J Cardiothorac Surg. 2014;46:737–9.

    Article  Google Scholar 

  31. Venuta F, De Giacomo T, Rendina EA, et al. Thoracoscopic pleural tent. Ann Thorac Surg. 1998;66:1833–4.

    Article  CAS  Google Scholar 

  32. Kawachi R, Matsuwaki R, Tachibana K, et al. Thoracoscopic modified pleural tent for spontaneous pneumothorax. Interact Cardiovasc Thorac Surg. 2016;23:190–5.

    Article  Google Scholar 

  33. Pompili C, Xiumè F, Hristova R, et al. Regulated drainage reduces the incidence of recurrence after uniportal video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax: a propensity case-matched comparison of regulated and unregulated drainage. Eur J Cardiothorac Surg. 2016;49:1127–31.

    Article  Google Scholar 

Download references

Acknowledgments

Conflict of Interest Statement: The author has no conflicts of interest to declare.

Consent: This chapter shows pictures and videos of two cases operated by our group. Written informed consent was obtained from both patients for publication of the selected material.

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Hospital Federal do Andaraí, Rio de Janeiro, RJ, Brazil

    Fernando Vannucci

  2. Department of Thoracic Surgery, Hospital Central da Polícia Militar, Rio de Janeiro, RJ, Brazil

    Fernando Vannucci

Authors
  1. Fernando Vannucci
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China

    Diego Gonzalez-Rivas

  2. Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China

    Calvin Sze Hang Ng

  3. Service of Thoracic Surgery, Department of Surgery Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Gaetano Rocco

  4. Gary Hock Endowed Professor of Surgery, Duke University Medical Center, Durham, NC, USA

    Thomas A. D’Amico

Electronic Supplementary Material

This video is about the same case shown in Figs. 2, 3, and 4 and shows a bulla at the left lower lobe, as well as its dissection/isolation away from the adjacent structures: the left upper lobe and a major pulmonary arterial branch to the left lower lobe (MP4 730450 kb)

Resection of the bulla using endoscopic staplers, after retracting it up and away from the previously dissected adjacent structures: the left upper lobe and a major pulmonary arterial branch to the left lower lobe (MP4 438932 kb)

Final aspect of the surgical field after bullectomy, bleeding/air leaks checking and subsequent full lung expansion at the end of the procedure (MP4 173892 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Vannucci, F. (2019). Uniportal Bullectomy for Emphysematous Bullous Lung Disease. In: Gonzalez-Rivas, D., Ng, C., Rocco, G., D’Amico, T. (eds) Atlas of Uniportal Video Assisted Thoracic Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-2604-2_13

Download citation

  • DOI: https://doi.org/10.1007/978-981-13-2604-2_13

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-2603-5

  • Online ISBN: 978-981-13-2604-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation