Resection of Pulmonary Blebs and Bullae—Video 27

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CHAPTER 27 Resection of Pulmonary Blebs and Bullae—Video 27

Cynthia S. Chin, Scott J. Swanson

Introduction

One of the earliest and most widespread uses for video-assisted thoracic surgery (VATS) was for treatment of patients with spontaneous pneumothoraces. Bleb resection by VATS has become a standard procedure, but the method for pleurodesis remains controversial. Studies of treatment of spontaneous pneumothorax have not been able to show one method of pleurodesis to be more successful than another. Video-assisted resection of bullae is part of lung volume reduction surgery for the treatment end-stage emphysema. Indications for this type of operation are too extensive to discuss in this chapter, which reviews important points for bleb and bullae resection.

Approach to Video-Assisted Resection of Pulmonary Blebs and Bullae

Order of Operative Steps

The order of the steps of the operation is lysis of adhesions, visualization and palpation of the bleb, resection planning, resection with pericardial strips, and checking for air leaks. The final step of pleurodesis is discussed in Chapter 21.

Key Points

♦ Adhesions may be present secondary to previous pneumothoraces and pleural irritation.
♦ Lung malignancy has been found within blebs and bullae.

image Video-Assisted Resection of Pulmonary Blebs and Bullae (Video 27)

Step 1. Port Placement

♦ Place the camera port in the seventh intercostal space in the anterior axillary line; it is modified depending on heart size.
♦ Place the access port in the fourth intercostal space in the mid-axillary line.
♦ Place the posterior port in the sixth intercostal space just inferior to the tip of the scapula.

Step 2. Lysis of Adhesions

♦ Exposure: Retract the lung away from the adhesion.
♦ Aim the thoracoscope anteriorly with the 30-degree lens pointed toward the adhesion.
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