Uniportal Bullectomy for Emphysematous Bullous Lung Disease

  • Fernando Vannucci


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.


Bullous emphysema Giant bullae Bullectomy Uniportal VATS Single-port VATS 



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.

Supplementary material

Video 1

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)

Video 2

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)

Video 3

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)


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Fernando Vannucci
    • 1
    • 2
  1. 1.Department of Thoracic SurgeryHospital Federal do AndaraíRio de JaneiroBrazil
  2. 2.Department of Thoracic SurgeryHospital Central da Polícia MilitarRio de JaneiroBrazil

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