2023-11-20 12:06:13
“It feels weird to talk again.” Identified only by her first name, Karine, the patient, aged 49, had been breathing through a tracheotomy for around twenty years, without being able to speak, due to complications linked to intubation after a cardiac arrest in 1996.
A few days after the transplant, carried out on September 2 and 3 in Lyon, she was able to say a few words. She has since followed vocal cord, swallowing and breathing rehabilitation sessions with a speech therapist, in the hope of lastingly regaining the use of speech. Her immunosuppressive treatment was reinforced following the onset of rejection but she was able to return home to the south of France on October 26.
She was therefore not expected to participate in the presentation of the intervention on Monday, but explained in writing that she had volunteered ten years ago “to return to a normal life”. “My daughters had never heard me speak,” she writes, ensuring that she is armed with “courage” and “patience” to face the pain and the work of relearning.
Professor Philippe Céruse, head of the ENT and head and neck surgery department at the Croix-Rousse hospital, also showed determination before coordinating this unprecedented transplant in France.
Rare interventions
The idea for this procedure arose during the world’s first larynx transplant, carried out in 1998 in Cleveland, in the United States, on a man who had lost his vocal cords in a motorcycle accident.
The surgeon inquired but left it there, until 2010 when, “a little by chance”, he met during a conference a Colombian colleague who reproduced this very delicate graft without ever publishing anything.
Dr. Luis Fernando Tintinago Londono invites him to Cali for a week to show him how to remove a larynx, “one of the most complex aspects” because this organ “is innervated by very small nerves and vascularized by very small arteries and veins which intersect,” as Professor Céruse explains.
For the next decade, he trained with a team of experts, obtained approvals, and began looking for eligible patients. In 2019, “Karine” was identified. But Covid interrupts everything.
In the meantime, two larynx transplants have been recorded in the medical literature, one in California in 2010 and one in Poland in 2015. This is not much because these operations are not a priority: a dysfunctional larynx is very disabling but does not pose a risk. endangering the lives of patients.
27 hours of intervention and more than sixty people mobilized
In 2022, the French team gets back to work. It remains to find a compatible donor, which for a larynx requires “anatomical characteristics perfectly compatible with the recipient, in terms of sex, weight, height, blood group…”. This happens on September 1st. After the family’s agreement, the intervention can begin. It will last 27 hours in total, around ten hours for the collection and 17 for the transplantation.
Twelve surgeons and around fifty staff members from the Lyon University Hospital took part in this first under the coordination of Professor Céruse and his colleague Lionel Badet, head of the urology and transplant surgery department at the Édouard Herriot hospital.
We will have to wait a full year to ensure the definitive success of the transplant but Professor Céruse “thinks he can say that there will be other” larynx transplants in Lyon.
Lyon hospitals have already hosted the world’s first transplant of a hand in 1998, and of both hands, in 2000, carried out by Professor Jean-Michel Dubernard, one of the pioneers of transplantation who died in 2021.
Professor Badet recalls having participated in this “adventure of transplantation” which opens up to new specialties. And to project that after the arms, forearms and larynx, tomorrow it would be the turn of “uterus and penis transplants”.
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