Feasibility and preliminary clinical outcomes of medical thoracoscopic bulla volume reduction for giant emphysematous bulla.

BACKGROUND

Giant emphysematous bulla (GEB) is a form of emphysematous lung destruction and patients experience progressive dyspnea and decline in quality of life. Conventional surgical reduction is not available for all patients, especially those in poor condition, and a less invasive approach is needed.

OBJECTIVES

This study aimed to evaluate the feasibility and preliminary clinical outcomes of medical thoracoscopic bulla volume reduction for GEB.

DESIGN

Single-center retrospective observational study.

METHODS

A total of 35 GEB patients who underwent medical thoracoscopic bulla volume reduction were retrospectively analyzed. Preoperative and postoperative clinical data and chest computed tomography were collected. The feasibility of the technique was evaluated by radiological changes (bullae volume and diameter) and postoperative complications. Improvement in dyspnea was assessed using the modified Medical Research Council (mMRC) dyspnea scale. Accessible six-minute walk distance (6MWD) and spirometry test follow-up data were analyzed to assess preliminary clinical functional improvement.

RESULTS

The targeted bulla volume was 1183.8 ± 636.7 mL preoperatively and decreased to 169.2 ± 237.2 mL postoperatively, representing an 87.7 ± 17.1% decrease compared to the baseline. A total of 91.4% (32/35) of the patients achieved more than 50% volume reduction relative to baseline, and the diameter of the targeted bulla also showed a significant decrease (p < 0.0001). Nine subcutaneous emphysema cases and one thoracic infection case were reported as postoperative complications. In the overall population, the mMRC score decreased by 1.2 ± 0.6 points at the 6-month follow-up. Available follow-up data on 6MWD and spirometry tests also showed improvement.

CONCLUSION

Medical thoracoscopic bulla volume reduction may represent a feasible and less invasive therapeutic option for patients with GEB and demonstrated preliminary clinical outcomes.