Lung transplantation remains the only curative option for patients with end-stage, medically refractory respiratory failure. Traditionally, the clamshell incision has been the primary surgical approach, as it provides extensive access to the mediastinum and bilateral pleural cavities. However, it is also associated with notable drawbacks, such as an increased risk of sternal nonunion and wound complications, which can impede postoperative recovery. This article introduces an alternative approach—double lung transplantation using video-assisted bilateral anterior thoracotomy. We present a detailed step-by-step surgical guide, offer practical tips, and highlight the advantages of this method over the conventional clamshell incision.

Keywords: Lung transplantation, Video-assisted thoracic surgery, Thoracotomy