Thoracoscopic carbon dioxide laser therapy for bullous emphysema

Surgical therapy for patients with severe bullous emphysema still remains controversial. As surgical bullectomy is generally limited to patients with single or a few giant bullae, patients with multiple bullae and bullous emphysema are not considered to be candidates for conventional surgical bullectomy. We performed thoracoscopic carbon dioxide laser ablation in four male patients aged 52 to 71 years with multiple bullae and bullous emphysema. All patients had their chest tubes removed 2 days postoperatively and went home within 40 days. There was no morbidity and no mortality. Postoperative chest computed tomography showed remarkable shrinkage of bullous areas in one patient. Postoperative pulmonary function tests showed slightly increased one second forced expiratory volume (0.35 ± 0.1 liters preoperatively to 0. 42 ± 0.2 liters postoperatively) and slightly decreased vital capacity (1.72 ± 0.4 to 1.52 ± 0.4 liters). Two patients showed improvement in exercise tests and subjective improvement of dyspnea on exertion. We conclude that thoracoscopic carbon dioxide laser ablation is a safe and beneficial treatment for certain patients with severe bullous emphysema.