Two cases of severe bullous emphysema were treated by thoracoscopic lung surface coagulation with Nd: YAG laser. In case 1, a 68-year-old man was admitted to our hospital with 3-year history of shortness of breath on exertion. A CT scan revealed a large bulla of the right upper lobe and diffuse bullous emphysema of the both lobes. The large bulla was resected by liner stapler, and the other right lung surface was coagulated and shrunken by contact Nd: YAG laser (8-10W). In case 2, a 76-year-old man was admitted to our hospital with shortness of breath on exertion after preveous five times spontaneous pneumothorax. A CT scan revealed diffuse bullous emphysema of the both lobes. The right lung surface was coagulated and shrunken in the same manner as case 1. Air leakage persisted for 13 postoperative days in case 1 and for 10 postoperative days in case 2, but the postoperative course were uneventful in both cases. At 1 to 3 months postoperatively there was increase in forced expiratory volume in 1 second% (from 33.3% to 41.7% in case 1, from 32.2% to 46.6% in case 2), decrease in%residual volume (from 172.8% to 140% in case 1, from 162% to 149% in case 2), and the dyspneic symptoms were improved in both cases. Thoracoscopic lung surface coagulation with Nd: YAG laser is a possibility of an effective treatment of bullous emphysema.
