Robotic-Assisted Bronchoscopy for Volume Reduction of Giant Emphysematous Bulla: A Case Report

We report the first successful case of volume reduction of a giant emphysematous bulla (GEB) using the latest shape-sensing robotic-assisted bronchoscopy (ssRAB). The patient was a 70-year-old male with chronic obstructive pulmonary disease (COPD) who developed GEB. He had previously undergone endobronchial valve (EBV) removal due to pneumonia caused by long-term implantation of EBVs for bulla volume reduction after a left emphysematous bulla rupture and subsequent pneumothorax. The patient visited our hospital for gradually worsening shortness of breath over two months. Chest radiography and computed tomography (CT) showed a GEB compressing 60% of the right lung volume, with the largest part filling the entire cross-section of the right lower lung. Under general anesthesia and with the assistance of ssRAB, we precisely punctured the bulla, safely aspirated the gas within the bulla, and injected medical adhesive to close the bulla. Postoperatively, the patient's shortness of breath improved significantly, and a CT follow-up six months later showed that the bulla had reduced to about half of its original size. Our experience indicates the feasibility and potential benefits of the novel ssRAB for volume reduction of GEB. The long-term efficacy and safety of using ssRAB to reduce GEB need to be evaluated by larger-scale studies.