Median Sternotomy for Lung Transplantation

A range of incisional techniques are available to lung transplant surgeons. Since the early 1990s, the standard for those undertaking bilateral lung transplant surgeries, particularly for septic disease, has been the clamshell incision or its anterior thoracotomy variants. There are potential problems of either incisional instability or reduced access. A relatively unused alternative that is very familiar to all cardiac and many thoracic surgeons is median sternotomy. Although pleural adhesions can cause a spectrum of difficulties, in their absence, the advantages of rapid opening and closure, combined with reliable stability and minimal discomfort, make this an attractive option. A series of evolved surgical maneuvers, with an emphasis of what can be done intrapericardially, facilitates this approach, and we describe them in this article.