Blebectomy

 

The tissues of the lungs are usually uniform. ​They look and feel smooth, like a sponge.

The lung can develop weakened areas. These are like small bubbles that bulge out from the rest of the lung. These bubbled-out areas are called blebs.  

If blebs become large, they are called bullae (pronounced BULL-eye).  

Often, blebs and bullae do not cause symptoms, unless they become very numerous or large. 

It is possible for blebs to burst, in which case air can be released from the lung into the chest cavity. This is called a pneumothorax.

 

"Pneumo" comes from the Greek word for air and thorax refers to the chest. So a pneumothorax is air in the chest, outside the lung. A pneumothorax is often called a collapsed lung by non-physicians. 

A pneumothorax will often cause a person shortness of breath or chest pain. Up to 10% of people may be asymptomatic despite having a pneumothorax. 

If there is no particular reason for the pneumothorax, then it is called a spontaneous pneumothorax. Often, a patient has a bleb or belbs and didn't know it, one of the blebs ruptured, and the lung collapsed. 

As the air collects in the chest, the pressure may increase and the lung collapse more and more. This is called a tension pneumothorax. A tension pneumothorax is an emergency and requires immediate treatment with a chest tube. 

If a patient does not have a tension pneumothorax and especially if the pneumothorax is small, sometimes observation is all that is needed. A chest x-ray 6-12 hours later may be performed and if the pneumothorax does not worsen, the patient may not require intervention. 

More commonly, a chest tube is placed to treat the pneumothorax. This is a procedure done at the bedside. Some pain medicine is given, the side of the chest cleansed and numbed, a small incision made, and the tube inserted. The tube is connected to a collection chamber. 

If the ruptured bleb - which is now a tiny hole in the lung - seals, then no additional air will be added to the pneumothorax and the chest tube will help to expand the lung back to normal size. 

The first time a patient has a spontaneous pneumothorax, most of the time a chest tube is the only therapy needed. Once the lung seals and the tube is removed, the patient can go home. 

However, if a patient has a second pneumothorax, then consideration is usually made to perform blebectomy. 

It is said that the risk of having a second pneumothorax is around 40% after a spontaneous pneumothorax. So many patients will not have a second pneumo. But if a patient has a second pneumothorax, the risk of having a third is 60%, so most of those patients will benefit from an operation. 

Blebectomy refers to an operation in which the blebs are removed. This helps to reduce the risk of another bleb bursting and causing a pneumothorax again. 

Often, a CT scan is performed in order to determine the number and position of blebs, prior to operation. 

Many times, the blebs are at the top of the lung, though blebs can be located in any position of the lung. 

In addition to blebectomy, most surgeons will perform a pleurodesis at time of operation. 

A pleurodesis is intended to help the surface of the lung stick to and heal to the surface of the ribs. 

If the lung will heal well to the ribs, then even if a bleb were to burst, the lung will not collapse.

Thus, it is important to remove the blebs, because then there is no abnormal lung to burst, but the safety net is the pleurodesis, which will help the lung not to collapse, even if a bleb were missed and were to burst.

 

Blebectomy is often performed for young patient, those in their 20s and 30s. Sometimes, blebectomy is used for older patients who have emphysema. 

 

If blebectomy and pleurodesis is needed, a robotic approach can be used for most patients.  

ROBOTIC

Dr. Pool uses the daVinci robot for almost all of the blebectomies he performs. 

Robotic blebectomy is performed with a general anesthetic. 

The 10X magnification of the robot camera allows for excellent visualization of the lung and thoracic anatomy. 

The lung is carefully inspected for blebs. If a CT scan was performed prior to operation, this scan can help guide the inspection to find the blebs.

A robotic stapler is used to remove the blebs. Usually, all of the blebs can be removed. In rare cases, there may be so many blebs that all of them cannot be safely removed. 

Once the blebs are removed, Dr. Pool usually performs pleurodesis. This is done with a mechanical method for most patients. 

Robotic blebectomy (and pleurodesis) usually takes Dr. Pool about an hour to perform. 

A drainage tube is inserted at the end of a robotic blebectomy. 

Most patients go home in 2-3 days, after the drainage tube is removed. 

Dr. Pool has performed many robotic blebectomy operations.  

God bless & heal you! 

J. Mark Pool, MD

ABTS Board-certified

214-692-6135

Member of Society of Thoracic Surgeons