Commentary: I wouldn't recommend trying this…

Central MessageThe Toronto Lung Transplant group is the best in the world…this is an example.See Article page 400. The Toronto Lung Transplant group is the best in the world…this is an example. See Article page 400. This commentary is being written for JTCVS Techniques as an appraisal of the Toronto group's successful transplantation of a patient with Mounier-Kuhn disease who had undergone a previous tracheobronchoplasty.1Dunne B. Lemaître P. de Perrot M. Chaparro C. Keshavjee S. Tracheobronchoplasty followed by bilateral lung transplantation for Mounier-Kuhn syndrome.J Thorac Cardiovasc Surg Tech. 2020; 3: 400-402Google Scholar I wasn't sure what to say here, but after some period of introspection, I compiled the following thoughts: (1) that looks really hard; (2) it could have gone horribly wrong; (3) no one should be encouraged to try to repeat this procedure/technique; (4) this group really is just better than most of us. With regard to that last point, have you ever seen Prince's performance of “As My Guitar Gently Weeps” in a tribute to George Harrison from the Rock and Roll Hall of Fame ceremony in 2004? Perhaps not. Well, Prince is on stage with a number of other notable musicians and is largely in the background until the end. He then comes to the front of the stage and launches into the most effortless, astounding guitar solo. In the midst of this demonstration of ethereal musicianship, the look on the face of the others on stage is disbelief and complete submission to the superiority of their peer. That's how I felt reading this case report. Now back to (1) to (3). In theory, this journal is designed to spotlight innovative—or at least thoughtful—approaches to thoracic disease that can then be applied elsewhere. I feel compelled, as someone who does lung transplantations, to discourage others from attempting such a heroic case. First, note that even before the case, erosion of the previously placed mesh was noted in the distal trachea. It is quite possible that in the process of mobilizing the right mainstem bronchus, additional unrepairable damage might have occurred. This is a particularly chilling thought when one considers just how short the right mainstem bronchus is and how in normal instances the anastomosis is placed closed to the carina, leaving very little room for error. Second, the anastomosis must then be performed to the residual bronchus that is inflamed and likely thickened from previous mobilization and mesh placement. Sounds like it might have been hard, right? Finally, one must always worry about ischemia at the bronchial anastomosis, and I would consider that to be of particular concern here, given the previous surgery and the amount of dissection that was necessary to prepare the right bronchus. The line between self-confidence and hubris is a fine one. The implications of crossing that line in most walks of life are generally limited to embarrassment of the individual or a scolding from a superior. In our field, life hangs in the balance, and hubris is more than just an unbecoming character flaw. JTCVS Techniques provides solutions to problems, and many of the described techniques are applicable to a general population. Consequently, one can take what one reads, add variability to their practice, challenge themselves, and in so doing acquire the acumen and self-confidence that comes with time. This isn't one of those instances. Attempt this one, and your scalpel will gently weep. Tracheobronchoplasty followed by bilateral lung transplantation for Mounier-Kuhn syndromeJTCVS TechniquesVol. 3PreviewMounier-Kuhn syndrome (MKS), also known as idiopathic tracheobronchomegaly, is a rare cause of tracheobronchomalacia.1 We present a case of a patient who required surgical treatment of his large airways disease followed some years later by bilateral lung transplantation for parenchymal disease. The clinical decision making related to performing a Marlex (Bard, Murray Hill, NJ) mesh tracheobronchoplasty in a patient likely to require lung transplantation and the technical challenge of bronchial anastomoses after tracheobronchoplasty is described. Full-Text PDF Open Access

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