Awake giant bullectomy with uniportal video-assisted thoracoscopic surgery

Giant bullous lung disease presents unique challenges in thoracic surgery due to the large size of bullae and compromised respiratory function. This case report highlights the successful use of awake uniportal video-assisted thoracoscopic surgery (A-UVATS) in a high-risk patient with severe chronic obstructive pulmonary disease and a giant multiseptated bulla occupying the entire left lower lobe. Instead of traditional general anaesthesia, regional techniques, including thoracic paravertebral block and dexmedetomidine sedation, were employed to ensure safety and comfort. The procedure resulted in significant clinical improvement, with minimal complications, aside from a transient air leak. Post-operative recovery was uneventful, and lung re-expansion was confirmed via imaging. This case highlights the feasibility and safety of A-UVATS bullectomy in carefully selected patients, offering improved recovery and reduced perioperative risks. More research is needed to develop standardised protocols and evaluate long-term outcomes of awake thoracic surgical approaches.