With her lungs out of her body for nearly a week, a woman with severe infections was kept alive. The feat was accomplished by a team of surgeons at Toronto General Hospital, University Health Network (UHN). The case is reported in The Journal of Thoracic Cardiovascular Surgery.
Bold and Risky Operation is a Success
What do you do, as a thoracic surgeon, when your patient has severely infected lungs? You give her a lung transplant. However, there is a twist: while the organs have to be removed to prevent aggravation of the patient’s case, you also need to give her time to recover from the infection. So, you keep her without lungs for 6 days.
This sounds incredibly impossible, but this is what UHN’s Surgeon-in-Chief, Dr. Shaf Keshavjee, and two of his colleagues achieved, marking the very first time such a procedure has been performed in the world.
Dying With Lungs
Melissa Benoit was dying from a severe lung infection, back in April 2016, when the doctors decided to go for the surgery. Using technologically-advanced life support equipment, they were able to save her life.
“This was bold and very challenging, but Melissa was dying before our eyes,” narrates Dr. Keshavjee. “We had to make a decision because Melissa was going to die that night. Melissa gave us the courage to go ahead.”
Melissa was a cystic fibrosis patient for 3 years already when her lungs had to be removed. She would have frequent chest infections, and the last one was so severe that it caused her ribs to fracture, resulting in her lungs becoming filled with blood and other materials like mucus—it was as if she were perpetually drowning. When she was brought to the hospital, she was sedated, and a ventilator was used to assist her in breathing. The situation quickly deteriorated, and her lungs were eventually irreversibly damaged. Only one thing could save her: a lung transplant. However, donors were not yet found, and she was placed on a special device, the Extra-Corporeal Lung Support (ECLS), so that her lungs and heart could still do their job. But, this was not enough as her condition exacerbated.
Moreover, even if she had a transplant, her state would not allow it as she was too sick for such an intervention.
Living Without Lungs
Thoracic surgeon Dr. Marcelo Cypel then decided to remove the very source of the problem: the infected lungs. Dr Cypel worked with Dr. Shaf Keshavjee and Dr. Tom Waddell to do so.
It was no easy surgery.
“Technically, it was difficult to get them out of her chest,” says Dr Keshavjee.
Thankfully, the bold move did bear its fruits: it took the patient only a couple of hours to improve. She was, then, placed on modern support devices. A portable artificial lung called a Novalung device was linked to the arteries and veins of her heart so that her body could take in oxygen, and remove carbon dioxide. An external device known as extracorporeal membrane oxygenation (ECMO) was also used to allow the blood carrying the oxygen to flow throughout her body.
“The transplant procedure was not complicated because half of it was done already,” says Dr. Cypel. “Her new lungs functioned beautifully and inflated easily. Perfect.”
Hope For Others
As Melissa had her happy ending, the team of surgeons are now analysing similar cases to gauge the relevance and viability of the procedure for other patients.