Robotic-assisted lung decortication in the management of pleural space complications after lung transplant

Robotic-assisted decortication has not been reported in post-lung transplant patients. We reviewed 26 consecutive robotic decortication for lung entrapment syndrome from 2019 to 2024. The time from transplant to decortication was 516 days (IQR 260-887). No thoracotomy conversion was necessary. Median chest tube duration was 4 days (IQR 3-6.5), and median length of stay was 6 days (IQR 3-7). Eighty-eight percent of cases achieved complete lung expansion with a median 315 ml improvement in FVC and 235 ml improvement in FEV1. The most severe Clavien-Dindo complications included 1 take-back for airleak and 1 re-intubation. Robotic-assisted decortication was well tolerated, safe, and effective at removing the fibrotic pleural disease and reversing previously defunctionalized lung.