Q&A: Two robotically assisted lung transplant patients show positive outcomes

Key takeaways:

• Robotically assisted lung transplantation would be a minimally invasive surgery.
• A team in Spain has performed two successful robotically assisted single-lung transplants.

Over recent years, the use of robotics for diagnosing people with lung cancer has been seen as promising, and the FDA even cleared a robotic navigated bronchoscopy system in 2023 to locate pulmonary lesions.

Now, a team of experts is investigating the use of robotics for lung transplantation and has already performed two robotically assisted single-lung transplants, according to a press release from the International Society for Heart and Lung Transplantation.

Following transplantation, Alberto Jauregui Abularach, MD, PhD, chief of the thoracic surgery and lung transplant department at Vall d’Hebron University Hospital in Barcelona, Spain, and his team reported that both patients demonstrated positive wound healing and pain control.

Healio spoke with Jauregui Abularach to learn more about robotically assisted surgery, limitations of this type of transplant and goals for the future.

Healio: What does “robotically assisted” surgery mean?

Jauregui Abularach: Robotically assisted means that the surgeon performs the surgery with the help of a robotic platform because it improves his visualization and the movement of his hands, making the surgery more precise. The robotic platform translates the movement of the hands of the surgeon who is sitting at a console, the movement is in real time, and the hands and arms of the robot are very small, which allows them to be inserted into the patients’ body without the need to make large wounds.

Healio: Could you briefly describe the technology (ie, hardware and software) that it involves?

Jauregui Abularach: It is a very advanced technology that allows us to take the minimum invasion to its maximum exponent. Basically, it is made up of three pieces: the console, where the surgeon directs the movements of the robot; the robot itself, which has four arms for the different instruments that the surgeon will need during surgery and which translates its movements; and finally the “control tower,” which acts as the robot’s brain.

The three elements are interconnected with each other, and the information passes in real time from the console to the control tower and finally to the robot. It has a very sophisticated security system so the robot is not autonomous and cannot do anything without the surgeon’s orders.

Healio: What kind of training does this technology require?

Jauregui Abularach: Surgeons around the world who want to learn to use robotic technology need specific training. It is not a training dedicated to teaching how to operate but rather to control the entire robotic platform. We have seen that the learning curve is much faster compared with other types of nonrobotic technology used for surgeries.

Healio: What were the outcomes of the two robotically assisted single-lung transplants your team performed? How do these outcomes compare with common outcomes of non-robotically assisted transplants?

Jauregui Abularach: In general, the patients followed a recovery very similar to that experienced by patients with lung transplants using the conventional technique, but there was a significant difference: the wound healing process was very satisfactory (the surgical wounds with the robotic technique are very small) and postoperative pain control was based on very mild medications.

These are still very preliminary results, and more experience is needed to confirm these very satisfactory results, but of course it is very exciting to know that there is a possibility that we can practically eliminate the pain that affects lung transplant patients.

Healio: What are some advantages of robotically assisted lung transplants compared with standard transplantation surgeries?

Jauregui Abularach: Above all, faster recovery and better pain control allowing patients to recover their usual lifestyle more quickly.

Healio: What are limitations of this type of transplant? What efforts have you taken thus far to address these limitations?

Jauregui Abularach: The biggest limitation is that not all centers that perform lung transplants in the world have robotic technology, and those that already have it have never thought about using this technology in a lung transplant. It is very important to spread the message that it is possible to perform a lung transplant with a technique as noninvasive as robotic surgery. It will be a long road, but I am sure that in the end, we will see how centers around the world will progressively adopt the technique, and thus we will be able to improve lung transplant surgery.

Healio: What factors make lung transplants more difficult than other transplants? How does this knowledge add to the potential use of robots in transplantation?

Jauregui Abularach: Lung transplant is one of the most complicated transplants because it is the only organ that is in contact with the outside world through respiration. The exterior adds many risks that make the transplanted organ more susceptible to damage. Traditionally, to perform a lung transplant it is necessary to open the chest with a very large wound, and we are talking about patients who already arrive very weakened by their lung disease. Being able to perform such a nonaggressive transplant on these patients is likely to be a paradigm shift.

Healio: What does your team hope to achieve in the near and far future?

Jauregui Abularach: My team is working to be able to offer robotic lung transplantation to more patients on the waiting list, taking the frontier to another level. We are sure that we will go hand in hand with improvements in technology since robotic platforms for surgery are improving every day. We are experiencing an exciting time in the world of lung transplantation, and we will continue working to improve the lives of our patients, which at the end of the day is the most important thing for us.

For more information:

Alberto Jauregui Abularach, MD, PhD, can be reached at albert.jauregui@vallhebron.cat.

Reference:

• Robotically assisted lung transplants are on the horizon. https://www.ishlt.org/about/news-detail/2024/04/11/robotically-assisted-lung-transplants-are-on-the-horizon. Published April 11, 2024. Accessed April 11, 2024.