A Successful Case of an Implanted Polyglycolic-Acid Sheet Inside the Bulla for Preventing the Residual Cavity After Video-Assisted Thoracoscopic Bullectomy

Abstract

Video-assisted thoracoscopic surgery (VATS) stapler bullectomy can be performed with minimal morbidity. The residual cavities are frequently observed postoperatively, especially in cases with wide large bullae. We describe a technique using an exclusive thoracoscopic approach utilizing a polyglycolic-acid (PGA) sheet for preventing the postoperative residual cavities in a patient with a large bulla. A 40-year-old man was referred to our hospital for progressive shortness of breath. Chest computed tomography (CT) revealed multiple bullae in the upper lobe of left lung. A large bulla had compressed a significant volume of functional lung parenchyma; VATS stapler bullectomy was performed. This procedure excised no normal lung tissue and reduced the volume of the air-containing cavity with airtight repair. A PGA sheet inside the bulla reduced and prevented air leakage from the stapled margin. The patient was discharged and the postoperative course was uneventful. Compared with preoperative expiratory volume in 1 s (FEV1), postoperative FEV1 increased by 0.66 L. Postoperative chest CT 16 months after surgery demonstrated no air-containing cavity. At 38 months after surgery, the patient had no symptoms.

Keywords

• bulla
• bullectomy
• polyglycolic-acid
• air leakage
• video-assisted thoracoscopic surgery