Fig. 4
Stepwise preparation of anastomotic cuffs for donor lung implantation. (A) Sequential isolation of hilar structures: pulmonary vein (PV), bronchus (Br), and pulmonary artery (PA); (B) Insertion of each structure into its designated cuff (PV and Br with 16G; PA with 18G); (C) Clamping of the cuff tail with bulldog forceps to maintain orientation during preparation; (D) Folding the vessel or bronchial tissue back over the cuff body for circumferential coverage; (E) Primary fixation of the folded edge using 6 − 0 multifilament silk suture; (F-G) Additional stabilization by anchoring the distal segment of the tissue to the cuff tail using 8 − 0 monofilament Prolene® suture; (H) Verification of bronchial lumen patency with microinstrument; (I) Verification of arterial lumen patency. Venous cuff patency was not routinely assessed due to short segmental branching. PV – Pulmonary vein; PA – Pulmonary artery; Br – Bronchus.
