217.8: How to Do It: Use of Octopus Tissue Stabilizer for Minimal Manipulation Approach of the Bronchial Anastomosis in Lung Transplant

Abstract

Introduction: Bronchial anastomotic complications (BAC) are a cause of grave concern for surgeons that perform lung transplantation. There are several risk factors that may lead to this complication, being inadequate surgical technique one of them, specifically regarding the adequate exposure and manipulation of the bronchial stump and anastomosis. Method: We report the use of the Octopus Tissue Stabilizer (Medtronic, Inc, Minneapolis, MN) as a mean of allowing for a better exposure of the stump and facilitate a “no touch” approach towards the anastomosis. Results: The Octopus Tissue Stabilizer (Medtronic, Inc, Minneapolis, MN) is a validated device for cardiac surgery as a tissue stabilizer for off-pump coronary artery bypass. It utilizes vacuum at the extremity of its “U” shaped claw to soothe the beating of the heart on a designated spot and assist the cardiac surgeon. Our idea was to employ the distal claw of such device to stabilize the bronchial stump and perform the bronchial anastomosis with a “no touch” technique. As we did not have a need to smooth the beating of the heart, the suction mechanism was kept turned off (FIGURE 1). It is important to report that in this case, as in others, several other techniques were applied to reduce BAC (the use of end-to-end anastomosis and pericardial flap), therefore it is impossible to affirm that the application of the Octopus Tissue Stabilizer (Medtronic, Inc, Minneapolis, MN) is responsible for the favorable outcome of this patient. Conclusion: We believe that the systematic application of devices that facilitate the employment of the correct surgical techniques can have an effect in reducing the incidence of BAC, while providing no additional risk to the patient.