What Is a Bullectomy?

A Surgical Procedure for COPD Patients With Giant Bullae

Surgeons performing surgery
Thierry Dosogne/Stone/Getty Images

If you have COPD and enlarged bullae, your doctor may recommend a bullectomy to help you breathe better. A bullectomy is a surgical procedure sometimes used in COPD patients to remove giant bullae from the lungs.

Bullae are thin-walled, air-filled spaces in the lining of the lungs that are enlarged to one centimeter or greater in diameter. This condition can occur in chronic obstructive pulmonary disease or COPD.

Bullae are the result of an obstruction within the bronchiole tubes or bronchus. Giant bullae cause substantial compression on the underlying, healthy lung tissue, which in turn, reduces blood flow and oxygen to the lungs. This causes a worsening of dyspnea, or shortness of breath.

When bullae grow too large, they can be removed by means of a surgical procedure called a bullectomy. Once they are removed, the healthy air sacs in the lungs can expand and breathing will become easier.

When is a Bullectomy Needed?

The procedure is considered whenever a substantial air-filled bullae is detected on chest x-ray or CT scan.

Most patients who are considered for surgery have symptoms including:

Other symptoms, though rare, include bleeding and infection in the bullae. Some patients have no symptoms but may require surgery if the bullae encompasses more than half of the pleural cavity — the fluid-filled area between the pleural membranes that surround the lungs.

If your doctor suspects you need a bullectomy, he or she will evaluate your lung function through one or more tests prior to surgery. Common tests ordered prior to a bullectomy include:

  • chest x-ray
  • chest CT scan
  • pulmonary function tests
  • ventilation/perfusion scan or VQ scan
  • lung angiography

Patients who have smaller bullae, hypercapnia, corpulmonale or an FEV1 less than 40 percent of predicted are not candidates for the surgery.

Before surgery is indicated, your doctor may try to manage your giant bullae without it. If you're asymptomatic, quitting smoking may be enough to manage the condition. If you still have symptoms after quitting smoking, medications and care such as bronchodilators, inhaled glucocorticoids, vaccinations, supplemental oxygen or pulmonary rehabilitation may help. If these still don't work, surgery is often the next course of action.

How Is a Bullectomy Performed?

Your surgeon may perform the bullectomy in one of two ways.

One is by thoracotomy, where a 4- to 6-inch incision is made below your armpit. The surgeon then inserts a lighted tube called a thoracoscope and surgical tools through catheters to remove the bullae.

The other option is a video thoracoscopy. Similar to traditional thoracotomy, video thoracotomy involves a video screen and console that guides the surgeon. It involves smaller incisions on the side of the chest. Once the bullae is removed, your surgeon will close the incisions.

Regardless of the method of bullectomy your surgeon chooses, the operation is performed under general anesthesia. This means you will need to fast prior to surgery. Be sure to follow all of your doctor's instructions.

Recovery from a bullectomy can take a few weeks until you regain your strength and are able to return to work. During this time, you should contact your doctor if you experience:

  • bleeding
  • infection in the incision
  • a high temperature
  • signs of an allergic reaction including redness, swelling and trouble breathing
  • pain


Meyers BF, Patterson GA. Chronic obstructive pulmonary disease. 10: Bullectomy, lung volume reduction surgery, and transplantation for patients with chronic obstructive pulmonary disease. Thorax. 2003;58(7):634-638. Review.

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