In Vivo Lung Perfusion
00:12 Surgical Plan
04:00 Surgical exposure
04:47 Hilar dissection
05:35 In Vivo Lung Perfusion
07:05 Lung perfusion setup
07:28 Perfusion system
- The patient was a 20-year old woman, diagnosed with multiple metastatic lesions from sarcoma in both lungs.
- In Vivo Lung Perfusion (IVLP) will be used to isolate the left lung and deliver a high dose of chemotherapy without systemic exposure.
- The left lung is deflated to expose the hilum and the left bronchus, pulmonary artery (PA) and pulmonary veins (LUPV and LLPV) are exposed.
- After administration of heparin, the LPA, LUPV and LLPV are cannulated.
- The LPA is ligated with a tourniquet clamp, and the LPVs are interrupted with a vascular clamp beyond the vein cannulation.
- The left lung is re-ventilated for the perfusion period.
- Blood leaving the left lung is diverted through the cannulas to a hard shell reservoir, where chemotherapy is administered, forming perfusate.
- The perfusate is then directed to a centrifugal pump, which drives the flow to a membrane gas exchanger, which is connected to a heater/cooler.
- At the membrane gas exchanger, a gas combination is added to deoxygenate the perfusate and provide CO2 for the inflow.
- The perfusate passes through a leukocyte filer and returns to the LPA through the cannula.
- After 3 hours of IVLP, the circuit is disconnected from the chemo, and connected to a bag of Perfadex to flush the lung in one pass.
- The pulmonary artery tourniquet is opened gradually to de-air the lungs, the cannulas are removed and venotomy sites repaired.
CT scans (axial)
CT scans (coronal)
Animation models (retopologized)
Shown here are the models used in the animation for this video, based on automatic 3D reconstructions of the pre-op scans.