An Experimental Training Model For Less Invasive Living Donor Lobar Transplantation.
Michael Peer1, Nachum Nesher1, Ygal Kasif2, Evgeni Gershman3, Vladislav Gofman4, Ehud Willenz4, Ahmed Elkholy5, Mordechai Kramer3, Eugenio Pompeo6
1Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel, 2Sheba Medical Center, Ramat Gan, Israel, 3Rabin Medical Center, Petach Tikva, Israel, 4Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel, 5Tor Vergata University, Roma, Italy, 6Tor Vergata University, Rome, Italy
Introduction: Living donor bilateral lobar lung transplantation (LDBLLT) (in adults and children) was developed in order to mitigate the growing competition for deceased donor lungs and resultant increase in waiting list mortality. At these techniques two donor lobes serves as an entire lung for each recipient. Less invasive technique: native upper lobe sparing, living donor, unilateral lobar lung transplantation (LDULLT) has reported as more effective and less complicated on the donor than the standard LDBLLT. Objective: Careful selection of donors to ensure adequately sized donor lobes improves outcomes and minimizes risk of complications. A creation of animal model for lobar harvesting instead of a whole lung by sparing the native upper lobes using meticulous surgical technique can increase the successes rate of lung transplantation. We reported of a training experimental study of native upper lobe sparing living donor unilateral lobe transplantation (LDULLT) in a porcine model to assess the quality of bronchial and blood vessels anastomosis and short-term post-surgical outcome. Methods: Unilateral native upper lobe sparing lobar lung transplantation was performed in 6 adult pigs through thoracotomy (4 right and 2 left). The animals were double lumen ventilated. Pulmonary vessels and lower lobe bronchus were carefully dissected and divided. The resected lobe was excised using less invasive techniques and preserved using cold preservation solution and ventilated for 30 minutes. Then through a larger thoracotomy, re-implantation of resected vessels and bronchus was performed. Blood flow and ventilation into the implanted lobe were re-new, air and blood leak were inspected. Quality of surgical technique was re-assessed by short term follow-up of the re-implanted lobe for vascular and bronchial strictures and immediate postoperative complications. Results: 5 animals survived the operation and 1 died. Pulmonary artery stenosis at the anastomotic sites were not observed, pulmonary veins stenosis was harder to inspect during surgery but since no post-operative lung ischemia was seen we assumed that none of the above was critical if occurred. So was the bronchial anastomoses on post-operative chest X-ray evaluating potential atelectasis. Conclusions: The described procedure provided excellent post- operative pulmonary function and good bronchial healing. The animal LDULLT model created an acceptable training program for better and less invasive future practice of LDULLT. In the endoscopic and robotic era, creating the unilateral living donor lobar harvesting animal models may reduce complications and donor's suffer therefore may open new horizons for less invasive LDLLT techniques in the future.
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