Anastomotic techniques for rat lung transplantation

Abstract

The first lung transplantation in the rat was achieved by Asimacopoulos et al using sutured anastomoses in 1971. Subsequent development of a cuffed technique to construct the anastomoses by Mizuta and colleagues in 1989 represented a breakthrough that resulted in simplification of the procedure and shorter warm ischemic times. Since then, a number of further variations on the technique of rat lung transplantation have been described. In spite of this, the procedure remains technically demanding and involves a long learning curve. This minireview describes the following new technical safeguards to further evolve the technique for cuffed anastomoses in rat lung transplantation: the use of anatomical landmarks to avoid twisting of the everted donor pulmonary vein and bronchus in the cuff, the use of the cuff tie as a landmark to avoid twisting of the anastomotic cuffs relative to the recipient vessels, distal ties on the recipient vessels to achieve a bloodless field and triangulation of the venotomy to avoid pulmonary vein tearing.

Rat lung transplantation model: modifications of the cuff technique

“…It is impossible to measure the intercostal space on a rat before surgery. Most previous reports that described the incision location, however, relied on different intercostal spaces (3)(4)(5)(6)10,11). Habertheuer et al (12) started the skin incision 1 cm below the inferior margin of the scapula, which is unreliable because of the scapula is easily mobilized.…”

“…Previous investigators often chose vessels as the first step. Rajab et al (11) addressed PV first, followed sequentially with the bronchus and PA. Sugimoto et al (9) went in the opposite direction, with the PA, bronchus, and PV, respectively. In our study, we anastomosed the bronchus first because, compared with vessels, it is structurally solid and easy to anastomose without laceration.…”

A modified orthotopic left lung transplantation model in rats

“… Anastomotic incision There are no mainstream yet personalized methods, including: The anastomotic incisions of the recipient's three tubes are all "—" shape incision on their trunk [ 42 , 47 ]. The anastomotic incision of the recipient's left pulmonary vein is a triangle incision on its trunk [ 13 ]. The left pulmonary artery's anastomotic incision is a “T" -shaped and the vein and bronchus are “V”-shaped [ 45 ].…”

“… Most rat endotracheal intubation tubes do not have a balloon, resulting in insufficient gas filling into the transplanted lung. Our maneuver could inflate the lungs conveniently, reducing the pulmonary vascular resistance of the transplanted lung and ensuring even reperfusion [ 13 ]. Opening order of the three hilum tubes after anastomosis Because the hilum is clamped by a pair of microvascular forceps, all three tubes open together after removing the vascular forceps.…”

“…Another obstacle is the absence of straightforward and effective anastomosis techniques [ 13 ]. While the transition from suturing [ 14 ] to employing cuffs [ 15 ] for anastomosis represents a revolutionary breakthrough in rat lung transplantation, the use of cuffs to anastomose also presents its own challenges.…”