VATS-stepwise resection of a giant bulla in an oxygen-dependent patient

We report a case of a giant: bulla in a 16-year-old boy who was oxygen and wheelchair dependent. He had been diagnosed with Marfan's syndrome and had severe kyphoscoliosis. The giant bulla occupying his entire left thoracic c avity compressed the contralateral lung. Until referral to our hospital, a bullectomy had been deferred during the preceding 5 years because of his po or pulmonary function and severe chest wall deformity. The patient was cons idered a candidate for thoracoscopic bullectomy, A stepwise resection techn ique was used, First, the bulla should be emptied by aspiration or wall per foration. Second, the redundant wall of the bulla should be resected by a l ooped Ligation without opening the cavity. Third, a stapled resection of th e downsized bulla should be performed. After a successful bullectomy, his s ubjective symptoms and pulmonary function improved. The reduction of the bu lla makes bullectomy easily and decreases the number of staplers, and reduc es operating time compared with opening the bulla and suturing it. Therefor e, when treating a giant bulla, we recommend a stepwise resection technique .