Name of the Procedure:

Thoracoscopy, surgical; with resection-plication of bullae, includes any pleural procedure when performed.

Summary

Thoracoscopy is a minimally invasive surgical procedure that allows doctors to view the chest cavity and lungs using a small camera inserted through a small incision. This specific procedure involves the resection (removal) and plication (folding and suturing) of bullae—large air-filled spaces in the lung that can cause breathing problems.

Purpose

Thoracoscopy with resection-plication of bullae is typically performed to treat conditions such as emphysema, where bullae cause difficulty in breathing or lung function impairment. The goal is to remove or reduce the size of these bullae, thereby improving airflow and lung capacity and alleviating symptoms like shortness of breath.

Indications

• Severe emphysema with the presence of large bullae
• Recurrent spontaneous pneumothorax (collapsed lung)
• Shortness of breath not manageable with medications or other treatments
• Significant impairment in lung function tests due to bullae

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustment of certain medications, especially blood thinners
• Preoperative diagnostic tests such as chest X-rays, CT scans, pulmonary function tests, and blood work
• Smoking cessation, if applicable

Procedure Description

1. The patient is positioned, and general anesthesia is administered.
2. Small incisions are made in the chest to insert the thoracoscope (a small camera) and surgical instruments.
3. The chest cavity and lungs are examined.
4. The identified bullae are resected (removed) or plicated (folded and sutured).
5. Any necessary pleural procedures are performed.
6. The surgical instruments are removed, and the incisions are closed with sutures or staples.
7. A chest tube may be inserted to drain air and fluid from the chest cavity and help re-expand the lung.

Duration

The procedure typically takes 1-3 hours, depending on the extent of the surgery and the complexity of the case.

Setting

Thoracoscopy with resection-plication of bullae is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Respiratory therapist (postoperative care)

Risks and Complications

• Infection
• Bleeding
• Air leak
• Pneumothorax (collapsed lung)
• Reaction to anesthesia
• Persistent pain or nerve injury
• Rare but serious complications like deep vein thrombosis (DVT) or pulmonary embolism (PE)

Benefits

• Improved lung function and breathing capacity
• Reduction in symptoms such as shortness of breath
• Potential decrease in the frequency of pneumothorax
• Improved quality of life

Recovery

• Patients typically remain in the hospital for 3-7 days post-surgery.
• Pain management with medications.
• Breathing exercises and physical therapy to enhance lung recovery.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor lung function and recovery progress.

Alternatives

• Medical management with medications and pulmonary rehabilitation
• Bullectomy (open surgical removal of bullae)
• Lung volume reduction surgery (LVRS)
• Lung transplantation (in severe cases)
• Each alternative has different risks, benefits, and implications for recovery.

Patient Experience

Patients are under general anesthesia during the procedure, so they will not feel anything. Post-operatively, patients may experience discomfort or pain at the incision sites, managed with pain medications. Breathing might initially feel uncomfortable due to the surgery and the presence of the chest tube, but improvements in breathing are often noticed within days to weeks. Special instructions will be provided for managing pain, caring for incisions, and monitoring for potential complications.