Robot-assisted thoracoscopic lobectomy as treatment of a giant bulla
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CASE REPORT
Open Access
Robot-assisted thoracoscopic lobectomy as treatment of a giant bulla Rosa Roemers1* , Kornelis Patberg3, Caroline van de Wauwer1, Tam Nguyen3 and Ghada Shahin2
Abstract Background: A bulla is a marked enlarged space within the parenchyma of the lung. Bullae may cause dyspnea by compressing healthy lung parenchyma and can cause a pneumothorax. Also, bullae are associated with malignancy, therefore surgical bullectomy is indicated on preventive basis. This case is unique and therefore valuable because of the remarkable presentation, innovative treatment and the spectacular improvement of lung function and socioeconomic performance of the patient. Case presentation: In this case report we describe the presentation, minimally invasive surgical treatment by means of a robot-assisted lobectomy and postoperative outcome of a young patient with a giant congenital bulla of the left upper lobe. Conclusions: In this case robot-assisted lobectomy has shown spectacular improvement of lung function and fast-track recovery with beneficial socio-economic performance in a young patient with a giant congenital bulla. Keywords: Giant Congenital Bulla, Bullectomy, Robot-assisted thoracoscopic lobectomy, Case-report
Background A bulla is a marked enlarged space within the parenchyma of the lung with thinning and destructed alveolar septa; it has a diameter greater than one centimeter in the distended state. If the bulla occupies at least 30% of a hemithorax it is considered a giant bulla [1]. A bulla may reach a considerable size and occasionally ruptures leading to pneumothorax [1, 2]. Mediastinal displacement and compressive effects of the affected lung can be caused by a large bulla. Many patients with giant bullae are asymptomatic but symptoms might include dyspnea due to compression of otherwise healthy parenchym, palpitations, chest pain or recurrent infections; however, when discovered treatment is imperative since these bullae may be associated with malignancy or in time degenerate into a malignancy. This was described by a number of case reports and series in which bronchogenic carcinoma developed within or adjacent to a giant bulla [3–7]. Diagnosis is made on chest radiography and CT scanning whereas detection of any associated malignancy requires more profound investigation especially in case of diffuse tumor growth. Radiographic patterns * Correspondence: [email protected]; [email protected] 1 Department of Cardio-thoracic Surgery, Universitair Medisch Centrum Groningen (UMCG), Hanzeplein 1, 9700 RB Groningen, The Netherlands Full list of author information is available at the end of the article
suggestive of a possible malignant process include nodular opacities within or next to the bulla, partial or multi focal thickening of the wall of the bulla, and secondary signs of the bulla such as pneumothorax, fluctuating diameter and fluid retention [8]. Endobronchial stenting with one-way endobronchial valves to deflate the bulla has been described [9]. However, based on the association with m
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