In October 2010, a hospital in Nanjing performed sequential double lung transplantation in a 42-year-old male patient. Preoperatively, chest CT and PET-CT showed multiple patchy and mass-like infiltrative shadows in both lungs, with no enlargement of mediastinal lymph nodes and no metastases in the rest of the body. Postoperative pathology confirmed stage IIIb mucinous fine bronchoalveolar carcinoma.
This was a surgery without the use of an extracorporeal circulation device (e.g., an artificial heart-lung machine).
After anesthesia and tracheal intubation, the right anterolateral incision was made first. The right lung had adhesions, and the surgeon first separated the chest wall and hilar adhesions, and separated the right pulmonary artery, right upper pulmonary vein, and right lower pulmonary vein stump within the pericardium, followed by resection of the right upper lung lobe and implantation of the right whole lung. Because of the small right thoracic cavity, the right whole lung could not be completely incorporated into the right thoracic cavity after expansion, and part of the lung was exposed outside the thoracic cavity to maintain the patient’s oxygenation (during anesthesia while maintaining adequate oxygen to the tissues and organs).
The left chest was opened in the same way, the left lung was free of adhesions, and the left diseased lung was successfully removed. After implantation of the left whole lung, the left chest was closed first, then the volume of the implanted right whole lung was reduced according to the size of the right chest cavity, and the right lower lung lobe was removed and the chest was closed.
The procedure was completed successfully in 6.5 hours, with a cold ischemia time (the time between the cessation of donor blood supply and the start of cold preservation of the transplanted lung) of 4 hours for the right lung and 6 hours for the left lung.
Postoperatively, the surgeon gave routine triple immunosuppression to prevent rejection and a series of antibacterial, fungal, and viral treatments. The patient was discharged 66 days after surgery with a good recovery. At 6-month postoperative follow-up, pulmonary function was good, with no significant signs of metastasis.
In recent years, new surgical materials, surgical instruments, and new surgical aids have been widely used in the clinic, and surgeons’ surgical proficiency and skills have improved, shortening operative time. A single-lung transplant without an E “artificial lung” can be done in as little as 3 to 4 hours, and a double-lung transplant in 5 to 6 hours.
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Co-Author: Dr. Zeng Fanjun, Guangdong Provincial People’s Hospital, Guangdong Lung Cancer Institute