During a traditional open surgery bilateral lung transplant, the surgeon opens the chest cavity with a clamshell incision, stretching from one armpit across the chest to the other, and breaks the sternum across the middle to access the lungs. The patient is placed on a heart-lung machine during the surgery, which averages six hours.
In contrast, surgeons at the Hannover School in Germany pioneered a minimally invasive lung transplant method, modifying the traditional technique to facilitate a minimally invasive approach. Prior to joining Cedars-Sinai as director of Aortic Surgery, Pedro Catarino, MD, was part of the team pioneering the procedure in England. He later served as director of transplantation at Royal Papworth Hospital in Cambridge, where he taught the procedure to dozens of surgeons, including members of the Smidt Heart Institute transplant team at Cedars-Sinai.
During a minimally invasive bilateral lung transplant, the surgeon accesses the lung via 3-inch (or less) incision under the nipple. The patient's lung is deflated before removal, and the donor's lung is deflated before insertion. Specialized instruments and customized clamps are utilized, as the incision is too small for a surgeon’s hand. A long device is used along with a knot-pusher instrument to aid in the procedure. Orthopaedic dissolvable structures assist in closing the incision.
With less time needed to open and close the patient and control bleeding, the procedure can be performed in 45 minutes to an hour per lung, shortening the time in the OR and eliminating the need for a heart-lung machine during surgery. In contrast to the open approach, where surgeons may be rushed or need to address organs simultaneously while the patient is open, the minimally invasive approach enables the team to isolate focus on a single organ at a time.