Once the donor has been accepted, the recipient is brought to the operating room. Along with safety, patient comfort is a major objective for our team.
You will receive medicine that will allow you to relax. A breathing tube is inserted that will enable us to ventilate each lung separately during the procedure. Monitoring catheters are inserted carefully to enable us to ensure that your body and brain are receiving all the blood flow and oxygen that it needs during the procedure.
At the end of the surgery, we utilize a nerve-blocking device that cools the nerve fibers the chest wall and numbs the incision. This typically lasts for weeks after the procedure.
Type of Incisions
The type of incision depends on the type of transplant. While we generally favor double lung transplants over single lung transplants, there are many scenarios where a single lung transplant is a safer and more desirable option.
This is especially true in patients who are older with other significant comorbidities whereby a single lung transplant would allow the patient to receive a transplant more expediently and still gain the same amount of longevity as a double lung transplant.
For a single lung transplant, the incision is made under the breast fold and towards the back in the right or left. For a double lung transplant, we use an incision that spans the chest from left to right, which allows to see both lung spaces at once. The other two options include an up and down incision that we use if the patient’s anatomy is favorable for this or an isolated minimal access incision in the left and the right for the right candidate.
Your surgeon will review your case; your anatomy based on computed tomography images and then discuss the best approach with you prior to surgery. Once the surgeon has access to the heart and lungs, we decide whether the surgery can be done with or without cardiopulmonary support using the heart-lung machine. If we do need the heart-lung machine, we usually try to minimize the stress to the body by using a device called extracorporeal membrane oxygenation (ECMO), which provides just enough support with less inflammation.
Connections from the Lung
Next, the lung’s connections to the heart, including the pulmonary artery and vein, are identified and isolated. Once the new organ is safely near the hospital, we separate the blood vessels with a surgical sealing device. We separate the airway and remove the lung.
We have several important structures that we aim to protect but that are at risk during the surgery, these includes:
- Nerves to the vocal cords, esophagus and diaphragm.
- Lymphatic channels that bring lymph fluid from the body to the central veins.
- The esophagus, heart, and aorta are all carefully protected throughout the procedure.
Sometimes patients have had prior surgeries or special sealant fluids like pleurodesis instilled into the chest that makes the lungs harder to extract. This may add additional time and the possibility of a greater need for a blood transfusion. Once the lung is removed, we prepare the donor lung and bring it into the chest.
After bringing the donor lung into the chest, we sew the airway first; then we sew the pulmonary artery and the veins from the lung to the heart. We let the lungs receive blood flow and begin to ventilate. Once we complete both sides, we close the chest incision and transport you to the intensive care unit. There we will monitor closely to ensure the lungs are working well.
Potential risks that we look out for include the following:
- The lungs sometimes are slow to wake up and you may require a temporary tracheostomy tube in the neck to allow you to get out of bed and perform conditioning exercises.
- Bleeding is a possible complication. Occasionally there may be a need to return to the operating room to washout an area that fills with fluid from either minor bleeding or lymphatic fluid.
- We monitor all organs including the heart, brain, kidneys, liver and extremities.
Throughout the process, our care teams communicate regularly with you and your family to ensure that all questions are answered as best and promptly as possible.