Bullectomy

A bullectomy is a surgical procedure to remove one or more bulla(e) from your lungs. A bulla is a pocket of trapped air in your working lung tissue. It comes out of damaged tissue when you have bullous emphysema.

Why it’s done:

• To help you breathe better: Bullae are unhealthy lung tissues that can compress your normal lung tissue.
• To improve symptoms: Making more space by removing bullae can improve shortness of breath. Bullae are also linked to lung cancer, infection or repeated lung collapse.
• To treat a sudden collapsed lung (primary spontaneous pneumothorax): This condition makes it hard to breathe and causes chest pain.

How should I prepare?

You’ll likely need a chest X-ray and CT scan that can show where the bullae are and their size. Imaging can also show a collapsed lung. You may also need to do:

• Pulmonary function testing
• Cardiopulmonary exercise testing
• A six-minute walk test

For the best results, your healthcare team may suggest you do these things before surgery:

• Stop smoking.
• Use bronchodilator or inhaler therapy.
• Take part in a pulmonary rehab program.

What happens during this procedure?

A surgeon may access your chest through a large cut (thoracotomy) or several small cuts (minimally invasive approach). The minimally invasive approaches can take place through VATS (video-assisted thoracic surgery) or robotic surgery. In robotic surgery, your surgeon has complete control of the robotic instruments.

Your surgical care team will:

1. Give you anesthesia so you’ll sleep and won’t feel pain
2. Do a bronchoscopy to clear your airway
3. Use a machine with a breathing tube to help your other lung breathe
4. Deflate the lung your surgeon will work on
5. Cut into a bulla and remove most of its wall
6. Staple what’s left of the wall (about 2 to 3 centimeters, or 1 inch, high) into the base of the bulla
7. Remove the tools they use and often insert a chest tube to help the remaining lung re-expand
8. Inflate the lung your surgeon worked on
9. Stop ventilation (machine for breathing) and remove the breathing tube

How long does this procedure take?

The median time for this procedure is 90 minutes to over two hours. That means half of cases are below that range and half are above it.

What are the potential benefits and risks of this procedure?

A bullectomy procedure can help your lungs work better for many years afterward. You may find you can walk longer distances or climb more stairs than you could before surgery. You might have better results from the procedure if you only had one bulla or if the bullae were all in one area.

Occasionally, a surgeon can perform the same procedure on the other lung if bullae are present on both sides. This is often many months after the original surgery to allow for appropriate healing.

Your surgeon will do their best to prevent complications. But some are common. Complications may include:

• Air leak that lasts more than a week (most common)
• Heart rhythm problems
• Pneumonia
• Leaky heart valve
• Bleeding
• Chronic pain
• Fluid buildup in your lungs (pulmonary edema)
• Air trapped deep in your skin (subcutaneous emphysema)

In rare cases, some people can die from lung failure.

What happens after this procedure?

You’ll receive medicine for pain and supplemental oxygen. You may have a chest tube to drain fluid. A provider will usually remove it before you go home. Your healthcare team will ask you to get out of bed as soon as you can on the day of your bullectomy surgery. You can expect to start physical therapy the day after surgery.

If you had a collapsed lung, your provider will do a chest X-ray to make sure your lung expanded well.

Length of stay after surgery is usually more than one day. It’s often at least three days.

Follow-up visits

You can expect to have follow-up visits with your healthcare provider. You may have a chest X-ray within the first few weeks after surgery.

Contact your provider if you have shortness of breath or chest pain after surgery.