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Marcel Anssar
Rainer G. Leyh
Wolfgang Harringer
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Right arrow Lung - transplantation
Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2001;122:1196-1198
© 2001 The American Association for Thoracic Surgery

Evolving Technology (ET)

Video-assisted minimally invasive approach in clinical bilateral lung transplantation

Stefan Fischer, MD, MSc, Martin Strüber, MD, Andre R. Simon, MD, Marcel Anssar, MD, Michaela Wilhelmi, MD, Rainer G. Leyh, MD, Wolfgang Harringer, MD, PhD, Axel Haverich, MD, PhD Hannover, Germany

From Hannover Lung Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.

Received for publication April 4, 2001. Accepted for publication June 22, 2001. Address for reprints: Martin Strüber, MD, Hannover Lung Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany (E-mail: strueber@thg.mh-hannover.de).

Since the report on the first successful clinical lung transplant procedure by Cooper and the Toronto Lung Transplant GroupGo 1 in 1986, the operation has become an accepted treatment modality for end-stage pulmonary failure in various diseases.

The approach to bilateral lung transplantation has changed significantly since the inception of the operation. The original double-lung technique was performed through a median sternotomy with the recipient supported by cardiopulmonary bypass. The donor lungs were implanted en bloc with a single tracheal anastomosis. Although this operation was successful, its limitations became apparent as it was extended to more difficult cases. In 1989 the bilateral sequential operation was introduced and has become the current standard approach. The lungs are sequentially and separately implanted through an anterior transverse thoracosternotomy (clamshell incision).Go 2 This incision provides excellent exposure of the pleural space. However, many disadvantageous effects are associated with this extremely invasive approach. According to the literature and our own clinical observations, early postoperative pain after thoracotomy is a significant problem. Additionally, chronic post-thoracotomy neuralgia is seen in many patients, which affects the quality of life and often requires long-term use of analgesic drugs.Go 3 For the transplanted lung to function optimally, sufficient breathing activity is . . . [Full Text of this Article]




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