Bullectomy

What is it?

Bullectomy is a procedure in which 20% - 30% of the most diseased portions of the lungs are removed. Patients with one or a few giant bullae, (enlarged air sacs within the lungs that look like balloons and occupy one-third to one-half of the lung area) may be candidates for a VATS (video-assisted thoracic surgery) bullectomy. In a bullectomy, a surgeon removes the bullae, allowing surrounding healthier lung tissue to expand and work more efficiently.

Why?

Emphysema is a chronic disease of the lungs characterized by air-filled sacs (bullae) in the lungs. The lungs increase in size and you can become 'barrel chested' and very short of breath. The goal of surgery is to reduce the size of the lungs to allow them to fit better within the chest cavity. This allows the muscles used for breathing to work more efficiently and helps to keep the airways open to improve the sensation of breathlessness.

Preoperative Evaluation

Bullectomy surgery is major surgery. You will need to undergo several tests before surgery in order to determine if the procedure is right for you and to make the procedure as safe as possible. You may require some or all of the following:

Blood tests
Electrocardiogram (ECG)
Pulmonary function tests (breathing tests)
CT scans (CAT Scan)
Nuclear lung scan
Exercise testing

To get in shape for your surgery, you may need to participate in respiratory rehabilitation. Prior to surgery, you will be assessed in the Pre-Admission Clinic at London Health Sciences Centre's (LHSC) Victoria Hospital, located in Zone C Level 2, Room C2-600.

Procedures

Traditional sternotomy - the procedure is done through an incision (cut) in your sternum (breast bone), similar to open-heart surgery, the most diseased areas of the lungs are removed and the chest is closed. This procedure can be done through either a standard incision or as a Video Assisted Thoracic Surgery (VATS)

Time

The procedure takes about 3 hours and is done in the Operating Room at LHSC's Victoria Hospital.

Risks

As with all major chest surgery, there are risks. These include bleeding, infection, air leaks, respiratory failure, heart attack, irregular heartbeats, stroke, blood clots to the lung and sometimes death.

Before Surgery

DO NOT EAT OR DRINK ANYTHING including water, after midnight the night before the procedure unless instructed otherwise by your surgeon. Leave jewellery and other valuables at home.

Day of Your Surgery

You must register in the Admitting Department at Victoria Hospital, two hours before your scheduled operating time. You will be then be directed to the Perioperative Care waiting room. Please advise the volunteer of your arrival.

After Surgery

You will wake up in the post anesthesia care unit (PACU or recovery room). A breathing tube may be in your mouth to help with your breathing. Once you are able to breathe on your own, the breathing tube will be removed and you will be transferred to the Thoracic Observation Unit in Zone C Level 5.

You will have several tubes and intravenous lines (IV's). Some will be coming from your chest (chest tubes), your bladder, arms or neck. You will also have an epidural in your back for pain control. These tubes will be removed over the next few days.

Family and Friends

Family and friends may wait in the Perioperative waiting room. Your surgeon will come to speak with them following your surgery.

Pain

There is moderate to severe pain with this surgery. A variety of methods are used to control the pain. You will receive an epidural that can deliver pain medication directly to the spinal cord. You may also receive a suppository to help reduce the pain. These are started in the operating room before the procedure to help decrease the pain when you awake.

While in the Thoracic Observation Unit, your heart will be monitored very closely along with your vital signs and the drainage from all of your tubes. You may eat immediately after the surgery. To prevent blood clots from forming in your legs, you will be given a blood thinner as an injection twice a day.

Physiotherapy

You will be seen by the thoracic physiotherapist who will help you with deep breathing and coughing as well as getting you out of bed. Walking and early rehabilitation is very important after surgery.

Discharge

Once all of the tubes are removed, you should be ready to go home. The average length of stay in the hospital is 3 - 5 days. You must go home with either a friend or relative by private vehicle or taxi, NOT by public transportation. Most patients do not need home care support.

Dressings

A bandage will cover the sites where your chest tubes were. This bandage should be kept dry and left in place for 2 days. After 2 days, remove the bandage and gently wash the wound with mild soap in the shower. Further dressings are not needed, but you may cover the wound with dry gauze if there is any drainage from it. The sutures are dissolving so that there are no stitches to remove.

Activity

You are encouraged to do regular activities except:

No heavy lifting for 6 weeks
Do not drive a car for 2 weeks

You should undergo additional respiratory rehabilitation as soon as possible after the surgery.

Prescriptions

You will likely be given a prescription for pain medication and a stool softener to prevent constipation. Additional prescriptions may be given if needed.