Healthiest looking lungs ready to respirate the recipient!!
Lung transplantation is an accepted modality of treatment for advanced stage pulmonary disease that causes respiratory failure mainly in patients with Chronic obstructive pulmonary disease (COPD) and restrictive lung diseases such as idiopathic pulmonary fibrosis , cystic fibrosis, alpha1-antitrypsin disease, and primary pulmonary hypertension. Transplantations aren't extremely common simply due to the small number of donor organs available, making the waiting list longer and longer. During a double-lung transplant, patient is hooked up to a heart-lung machine. The surgery starts with the traditional incision used for bilateral lung transplantation, the clamshell incision, made under the patient's armpit, around to the sternum, and then back towards the other armpit. But the procedure may also be performed using separate bilateral sternal sparing anterior thoracotomies. Once the chest is entered, chest retractors are placed and the functionally worse side is transplanted first, with the intention of avoiding the need for extracorporeal support if possible. In the case of a quality difference between the donor lungs, for example, due to traumatic alterations or other minor impairments, the better lung will be transplanted first. During the entire procedure, attention must be paid to avoid phrenic nerve injury. On the left side the recurrent laryngeal nerve is also in an exposed location. In patients with infections, lung diseases or after pleurodesis (a procedure that obliterates the pleural space to prevent recurrent pleural effusion or recurrent pneumothorax), significant adhesions along the mediastinum can be encountered that must be mobilized with caution to avoid nerve injury. Once the lung is collapsed, the blood vessels clumped or tied off, and cut at the corresponding bronchi. The new lung is then placed, the blood vessels reattached and bronchial anastomosis is performed in a single running suture technique. To make sure the lung is satisfactory before transplanting the other, a bronchoscopy is performed.