Fig. 6
Stepwise overview of recipient implantation procedure in the rat orthotopic lung transplantation model. (A) Opening of the pericardial sac to expose the heart under microsurgical guidance; (B) Identification of the left hilar anatomy following thoracic exposure; (C) Hilar anatomy revealed following meticulous adjacent tissue dissection; (D) Pre-placement of 6 − 0 silk suspension sutures behind each hilar structure to assist cuff positioning (E) Application of a vascular clamp across the hilum to temporarily halt perfusion; (F) Recipient lumen openings created via venotomy, arteriotomy, and bronchotomy in sequence; (G) Identification of Prolene®-marked donor cuff tail as a visual guide for correct orientation during implantations; (H) Clamping the marked donor cuff together with the anterior arterial wall to stabilize alignment prior to final ligation; (I) Secure ligation of arterial cuff using the pre-positioned sutures; (J) Insertion of the arterial cuff and completion of the arterial anastomosis (K) Implantation of the bronchial cuff using the same technique; (L) Final implantation of the venous cuff, completing the triad of anastomoses; (M) Immediate transient reclamping of the pulmonary artery for 90 s following hilar clamp release; (N) Controlled reperfusion initiated after gradual arterial clamp release; (O) Excision of the native left lung to finalize graft integration; (P) Final appearance of a well-perfused, morphologically intact transplanted lung. PV – Pulmonary vein; PA – Pulmonary artery; Br – Bronchus.
