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A Comparative Study of a Sternum-Sparing Procedure and Clamshell Incision in Bilateral Lung Transplantation
Jong Myung Park1,2, Joohyung Son1,2, Do Hyung Kim1,2
1Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Yonsei Medical Journal
|November 22, 2023
Summary
Bilateral anterolateral thoracotomy (BAT) offers a safer, less invasive approach for lung transplantation compared to the traditional clamshell incision. This sternum-sparing technique leads to shorter recovery times and improved patient outcomes.
Area of Science:
- Thoracic Surgery
- Transplant Surgery
- Surgical Innovation
Background:
- The clamshell incision is a standard approach for lung transplantation, providing excellent pleural access.
- However, the clamshell incision is associated with a high rate of sternal complications, necessitating improvements.
- This study addresses the need for safer and more effective surgical techniques in lung transplantation.
Purpose of the Study:
- To compare the outcomes of transverse sternotomy with clamshell incision versus sternum-sparing bilateral anterolateral thoracotomy (BAT) for lung transplantation.
- To evaluate the safety and efficacy of BAT as an alternative to the clamshell incision.
- To determine if BAT reduces sternal complications and improves patient recovery.
Main Methods:
- A retrospective analysis of 134 bilateral sequential lung transplants performed between May 2013 and June 2022.
- Patients were divided into two groups: clamshell incision (n=34, May 2013-December 2017) and bilateral anterolateral thoracotomy (BAT) (n=100, January 2018-June 2022).
- Comparison of patient characteristics, operative times, mechanical ventilation duration, ICU stay, and in-hospital mortality between the two groups.
Main Results:
- The clamshell group had significantly longer operation times (745.18±101.76 min) compared to the BAT group (669.90±134.09 min; p=0.003).
- Mechanical ventilation duration was significantly longer in the clamshell group (17.26±16.04 days) versus the BAT group (11.35±12.42 days; p=0.028).
- Intensive care unit (ICU) stay was also significantly longer for clamshell patients (21.54±15.23 days) compared to BAT patients (15.03±14.28 days; p=0.033). In-hospital mortality was 26.5% for clamshell and 22.0% for BAT.
Conclusions:
- Sternum-sparing bilateral anterolateral thoracotomy (BAT) is a safe and effective alternative for lung transplantation.
- BAT is associated with reduced operative time, shorter mechanical ventilation, and decreased ICU length of stay compared to the clamshell incision.
- Avoiding sternal division with BAT promotes stable breathing, facilitates earlier ventilator weaning, and accelerates patient recovery.
