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Novel Method of Thoracoscopic Surgery for Giant Bulla without Residual Cavity

Department of General Thoracic Surgery, Takarazuka Municipal Hospital Hyogo, Japan

For reprint information contact: Tomoki Utsumi, MD, Tel: 81 6 6879 3152, Fax: 81 6 6879 3163, Email: utsumi{at}surg1.med.osaka-u.ac.jp, Department of Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, E-1, Suita-City, Osaka 565-0871, Japan.

A giant bulla is generally resected by thoracoscopic surgery. Resection using an automated stapling device is popular, however, a number of cartridges may be consumed and a cavity is sometimes left remaining, especially when resecting wide-based lesions. To establish a thoracoscopic surgical procedure that results in no residual cavity, we developed a method in which the roof of the bulla is resected first, followed by resection of the pulmonary parenchyma, including the base of the bulla, using a stapling device. Exposure of the base by first removing the roof facilitates determination of the resection line. Between 2003 and 2005, the procedure was attempted in 6 patients, which included one bilateral case. Conversion to a minithoracotomy was required in one patient because of bulla thickening. The operating time ranged from 80 to 150 min (median, 135 min) in the other 6 cases. Postoperative chest drainage ranged from 2 to 13 days (median, 3 days), and postoperative hospital stay was 5 to 18 days (median, 6 days). No adverse events occurred. We found this procedure to be simple and useful for complete resection of giant bullae.