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What Is a Bullectomy?

Pulmonary emphysema is caused by cigarette smoking.
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  • Written By: J. Leach
  • Edited By: Michelle Arevalo
  • Last Modified Date: 11 August 2014
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A bullectomy is the surgical removal of a bulla, or a thick-walled air space, that can be caused by emphysema, infection, or a congenital defect. While technically a bulla can occur anywhere in the body, they are most often associated with the lung. A bulla's size may vary, but they are generally between .25 inches (.635 cm) and .5 inches (1.27 cm). A surgeon may remove bullae from the lungs to encourage the healthy air sacs around it to expand, and allow the lung to function at a more efficient level. Bullectomies are merely a treatment, not a cure, for lung tissue damage caused by emphysema.

Pulmonary emphysema, which is also known as Chronic Obstructive Pulmonary Disease (COPD), is a disease of the lungs that is often caused by cigarette smoking. Lung tissues become damaged, enlarged, and no longer function efficiently. The alveoli, or air sacs of the lung, collapse and the tissue of the lung is not as elastic as it once was, thus greatly limiting lung capacity. Patients become short of breath and have difficulties absorbing adequate oxygen. Emphysema is a degenerative disease and is irreversible.

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Bullae arise as a symptom of COPD and can cause the progressive enlargement of tissues in the lungs, which can further damage the alveoli. Small bullae rarely compromise breathing. Very large ones, however, can make it extremely difficult because of the amount of space they take up and the pressure they can exert on the surrounding tissues. Emphysema that is specifically characterized by bullae is called bullous emphysema.

Bullous emphysema can occur in healthy young adults. The alveoli in the upper part of the lungs become large and distended. If this is allowed to continue without treatment, the air spaces may rupture or burst. When bullae burst, air will leak from the lungs and the affected lung will eventually collapse. An apical bullectomy — a bullectomy to remove bullae from the upper portions on the lungs — is usually performed to help ease symptoms and prevent the lungs from collapsing.

Surgeons can perform a bullectomy in two different ways. The first method uses a video thoracoscopy to perform the bullectomy through a small incision in the chest. The doctor can view the bullae to be removed with an endoscope and cut them out. The second method requires a four inch (10.16 cm) to six inch (15.24 cm) incision in the armpit area. Using this technique, the doctor removes the bullae manually, through the patient's side.

Both surgical methods require quite a bit of time for the patient to heal. It is normal for the lungs to leak air after the bullectomy is performed. A chest tube is inserted to prevent the lung from collapsing, and remains in place until the patient is healed enough to breath freely.

A bullectomy can sometimes be confused with Lung Volume Reduction Surgery (LVRS). LVRS is typically used to treat a different form of emphysema that creates smaller, non-functioning air sacs, or alveoli, throughout the lungs. To perform this procedure, doctors surgically remove the portion of the lung that contains these non-functioning air sacs, in the hope of enabling the lung to function in a more efficient manner.

An ethmoid bullectomy is entirely unrelated to the lungs. It is a surgical procedure performed on the sinuses, and is more commonly known as a ethmoidectomy. The procedure usually entails the removal of all or part of the lining and bones separating the ethmoid sinuses.

The ethmoid is the bone in the skull that creates the eye and nasal cavities. To perform an ethmoidectomy, a doctor runs an endoscope through the nasal passage to remove bits of bone and tissue. This is usually done to improve drainage and reduce the occurrence, and severity, of sinus infections. An ethmoidectomy is usually an outpatient procedure, and requires only general anesthesia.

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