Left Single Lung Transplantation Through Left Anterolateral Thoracotomy With Longitudinal Partial Sternotomy...

Area of Science:

• Thoracic Surgery
• Transplantation Surgery
• Pulmonary Medicine

Background:

• Pulmonary fibrosis (PF) necessitates lung transplantation but presents surgical challenges, particularly for the left lung, due to anatomical changes.
• The hemiclamshell (HCS) approach, an anterolateral thoracotomy with partial sternotomy, is typically used for thoracic tumors and vascular lesions, not commonly for lung transplantation.
• Limited pleural space and lung retraction in PF complicate surgical access to the lung hilum.

Observation:

• A 62-year-old idiopathic pulmonary fibrosis patient with severe dyspnea underwent pretransplantation evaluation.
• Imaging revealed predominantly left-sided pulmonary fibrosis with reduced lung volume and impaired respiratory function.
• A left single lung transplantation was performed using a left hemiclamshell (HCS) approach.

Findings:

• The superior pulmonary vein was converted into a "neo-atrium" to facilitate atrial anastomosis during the lung implantation.
• The patient experienced an excellent post-operative recovery.
• Discharge occurred 26 days after the single lung transplantation procedure.

Implications:

• The hemiclamshell (HCS) approach is presented as a novel and effective surgical resource for left single lung transplantation in patients with pulmonary fibrosis.
• This technique may offer an alternative for managing the surgical complexities associated with lung transplantation in fibrotic lungs.
• Further investigation into the HCS approach for lung transplantation could expand surgical options for end-stage respiratory diseases.