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Fellow
Hana Ajouz, MD, Daniel Buitrago, MD, MPH, Yilam Rodriguez-Blanco, Padraic Malley, Tiago Machuca, MD, PhD, Mauricio Pipkin, MD;
University of Miami, Miami, FL, USA
Lung Autotransplantation: When and How?
Objective: Many eligible patients who can benefit from auto-transplantation are often denied surgery due to insufficient knowledge about its indications and proper execution. The objective of this video is to discuss the indications and technical steps involved in lung auto-transplantation.Case Video Summary: A 45-year-old male with metastatic testicular cancer status post four cycles of chemotherapy and complete response in 2020. In 2023, he was found to have 21 cm mass in the left chest, involving the left upper and lower lobes bronchi, as well as the interlobar pulmonary artery. Additionally, there was another 6 cm mass in the right upper lobe.-Procedure Overview: The surgery began with a clamshell incision and vertical sternotomy, followed by the isolation of the left main pulmonary artery and superior and inferior pulmonary veins for proximal control. Pneumonectomy was then performed. The left lower lobe was dissected free from the tumor, and frozen sections confirmed negative margins. As the superior segment of the left lower lobe was involved in the tumor, the superior segment artery was isolated, transected, and the involved superior segment was wedged out. Our next step was to auto-transplant the lower lobe. The left lower lobe bronchus was then anastomosed to the left main stem bronchus using running polydioxanone sutures in the membranous wall and simple interrupted polypropylene sutures in the cartilaginous wall. Subsequently, the left main pulmonary artery was anastomosed to the left lower lobe pulmonary artery using running polypropylene sutures. Finally, the left atrium was clamped, and atrial anastomosis was performed with running polypropylene sutures. Conclusion: In conclusion, it is crucial for thoracic surgeons to be aware of the indications for lung auto-transplantation, as it offers a viable alternative to pneumonectomy in certain patients. Auto-transplantation not only reduces morbidity and mortality but also preserves pulmonary function and allows for future surgical options. Combining lung transplantation with thoracic oncology techniques can greatly benefit this patient population by providing a lung-sparing techniques.
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