Table 2 Summary of technical refinements in rat orthotopic lung transplantation and their advantages.
Application / Procedural Phase | Conventional Status | New Modification | Advantages |
|---|---|---|---|
Anostomotic cuff preparation (Before procedure) | Cuff lenght; 2.8 mm (body 1.4 mm, tail 1.4 mm) | * During the cuff preparation; facilitate more secure suture placement along the cuff body * During implantation; prevents kinking of hilar structures | |
Anostomotic cuff preparation (Before procedure) | Cuff width; V:16G, B:16G, A:18G | * Sufficient lumen width for physiological flow * During implantation; reduces risk of injury to delicate vascular and bronchial structures | |
Application surface (Lung seperation & cuff preparation) | Soft-bristled brush within a Petri dish | * Protection of donor lung from compression induced injury encountered during manipulation | |
Pulmonary vein seperation (Lung seperation) | Dissection of the left pulmonary vein from the left atrium using a posterior approach | * Facilitating the excision of the left pulmonary vein at its longest possible length | |
Appropriate suture material (Cuff preparation & implantation) | 6.0 multifilament suture | * Enhances mechanical strength and durability | |
Reinforcement of the newly structured anastomotic cuff (Cuff preparation) | Grooving the cuff with serrated instruments, | Securing the tissue distal to the suture to the tail of the cuff using 8.0 monofilament suture after cuff preparation | * During implantation; preventing cuff–tissue detachment caused by push–pull movements * During implantation; acts as a guide to keep the cuff within the vessel and bronchus during implantation |
Utilization of procedure-specific custom-designed endotracheal tube (Donor procedure, recipient thoracotomy) | Procedure-spesific tube is designed by combining the dilator of the central venous catheter with the infusion line | * Complete sealing of the tracheal lumen to prevent retrograde leakage of positive-pressure air * Facilitates more efficient mechanical ventilator management | |
Retraction suture placement (Recipient thoracotomy) | No record | Placement of a retraction suture proximal to the tracheostomy after intubation | * Facilitates intubation in the lateral decubitus position when re-intubation is required |
Adjustment of the mechanical ventilator for single-lung ventilation (Recipient thoracotomy) | No Record | Initiation of ventilation with 65% of tidal volume after clamping the native left lung | * Prevents the right native lung from volutrauma-induced injury |
Sequence of anastomosis (Implantation) | A-B-V formation | * Adequate stabilization achieved through the initially performed arterial anastomosis * The donor lung approaching laterally into the operative field not limiting exposure for subsequent anastomoses * The most challenging venous anastomosis was facilitated by achieving sufficient stabilization of the donor lung beforehand | |
Implementation of controlled reperfusion (Implantation) | Release of the hilar clamp and initiation of reperfusion upon completion of implantation7,11,14 | Temporary occlusion of the pulmonary artery for 60–90 s after releasing the hilar clamp | * Allowing adequate time for retrograde blood flow to reopen the venous lumen, thereby preventing stasis and veno-occlusive complications * Ensuring controlled reperfusion to minimize ischemia–reperfusion injury |
Adjustment of the mechanical ventilator for double-lung ventilation (Implantation) | No Record | Initiation of ventilation with 85% of tidal volume after implantation | * Prevents the transplanted lung from volutrauma-induced injury |
Utilization of a respiratory mask (Recovery) | No Record | Utilization of small funnels, originally intended for filling thoracic drainage bottles, as improvised respiratory masks | * Provides high-flow oxygen supplementation during the post-extubation recovery phase |
