Robotic Lung Transplantation: Feasibility, Initial Experience, and 3-Year Outcomes

Area of Science:

• Thoracic Surgery
• Transplant Surgery
• Minimally Invasive Surgery

Background:

• Traditional lung transplantation incisions (clamshell, sternotomy) can increase morbidity and limit patient eligibility.
• Robotic lung transplantation presents a less-invasive surgical option, but comparative outcome data are limited.
• Evaluating midterm outcomes is crucial for informing treatment choices in lung transplantation.

Purpose of the Study:

• To compare midterm outcomes of robotic versus nonrobotic minimally invasive lung transplantation.
• To assess the safety and efficacy of robotic lung transplantation.
• To provide data for clinical decision-making regarding surgical approach.

Main Methods:

• Prospective registry of consecutive patients undergoing robotic or minimally invasive lung transplant (<6-cm minithoracotomy) from October 2021 to February 2025.
• Primary endpoint: 1-year survival. Secondary endpoints included postoperative pulmonary function, ventilator support, primary graft dysfunction, and hospital stay.
• Analysis used linear mixed-effects regression; median follow-up was 1.8 years.

Main Results:

• 209 lung transplants were performed; 111 were minimally invasive (21 robotic, 90 nonrobotic).
• Robotic cohort experienced longer waiting times and ischemic times but showed no significant differences in 1-year survival (95.0% vs 95.5%), graft dysfunction, or hospital stay compared to nonrobotic minimally invasive recipients.
• Postoperative pulmonary function and ventilator support (<48 hours) were also similar between groups.

Conclusions:

• Robotic lung transplantation is associated with midterm outcomes comparable to nonrobotic minimally invasive approaches.
• The technique is a feasible alternative despite longer ischemic times.
• Further research may explore long-term outcomes and expanded patient eligibility.