RT Book, Section
A1 Batirel, Hasan F.
A1 Zellos, Lambros
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Colson, Yolonda L.
A2 Jaklitsch, Michael T.
A2 Krasna, Mark J.
A2 Mentzer, Steven J.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1105843995
T1 Minimally Invasive Methods of Managing Giant Bullae: Monaldi Procedure
T2 Adult Chest Surgery, 2e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-178189-3
LK accesssurgery.mhmedical.com/content.aspx?aid=1105843995
RD 2024/04/17
AB Giant  bullae  are  space-occupying  lesions  that  cause  compression  of  the  surrounding  lung  parenchyma  with  impairment  of  lung  function.  The  bullae  arise  from  emphysematous  projections  of  destroyed  lung  tissue.  Hence  they  differ  from  blebs,  which  are  localized  collections  of  air  between  visceral  pleural  layers  without  underlying  parenchymal  disease.1  Giant  bullae  can  be  classified  as  three  basic  morphologic  types:  Type  I  bullae  have  a  narrow  neck  and  are  superficial,  type  II  are  superficial  as  well  but  have  a  broad  neck,  and  type  III  are  both  broad  and  deep.2  Giant  bullae  usually  require  surgical  resection.  A  wide  range  of  procedures  from  open  excision  to  plication,  drainage,  video-assisted  bullectomy,  and  lung  resection  can  be  applied.3  Developments  in  anesthesia  and  surgery  have  enabled  surgeons  to  operate  on  patients  with  very  limited  pulmonary  function;  however,  there  is  a  subgroup  of  patients  who  carry  a  significant  risk  of  prolonged  air  leak  and  respiratory  complications  following  resection  of  giant  bullae.  In  this  group  of  patients  a  minimally  invasive  method,  known  as  the  Monaldi  procedure,  can  be  performed.  The  Monaldi  procedure,  named  after  the  surgeon  who  first  applied  this  technique,  was  used  in  the  mid  and  late  20th  century  for  drainage  of  apically  located  tuberculous  cavities,  lung  abscesses,  and  subsequently  of  giant  bullae.4