Robotic surgery brings benefits to lung transplant procedures

The first-time procedure at Cedars-Sinai uses minimally invasive approaches, 3-D visualization and helps improve patient recovery.

Robotic surgery, utilizing three-dimensional imaging technology, is now able to give surgeons more precise capabilities in transplant surgery.

Most recently, cardiothoracic surgeons were able to use the technology to perform a minimally invasive lung transplant at Cedars-Sinai in its Smidt Heart Institute. The Los Angeles-based healthcare organization also operates the Comprehensive Transplant Center, and together completed 573 solid organ transplants in 2021.

This use of robotic surgery shows new promise in transplant surgeries, expanding the ability to use precise surgical techniques and less invasive surgical procedures that have the potential to improve patient outcomes, save money and facilitate procedures.

The robotic procedure is especially relevant because the COVID-19 pandemic has resulted in a surge in lung transplantations as a outgrowth of irreversible lung damage caused by the virus. An analysis by the Smidt Heart Institute showed that 7 percent of the 3,000 lung transplants that occurred between Aug. 1, 2020, and Sept. 30, 2021, were related to coronavirus infections.

The recent robotic-assisted lung transplant was performed to replace the right lung of a 69-year-old California man.

The procedure builds on the institute’s development of minimally invasive techniques for lung transplants. Teams at Smidt have developed approaches that use smaller incisions for lung transplants, with some incisions that are “no bigger than the short side of a driver’s license,” said Dominic Emerson, MD, the lead surgeon and associate surgical director of heart transplant and mechanical circulatory support.

As a result, transplants at Smidt now require small incisions between By contrast, typical lung transplants usually require the creation of a “clamshell” incision that involves cutting apart the breastbone.

In the robotic procedure, surgeons used the device to enter the body through two small holes on the side of the body. These portholes serve an additional function, as they’re used during lung transplant surgeries to place chest drains when a procedure is completed.

“With the robotic surgery, we still make the same incisions we make for our minimally invasive technique,” said Pedro Catarino, MD, director of aortic surgery. “The difference is that instead of a surgeon placing their hands in the incision between the ribs to complete the surgery, the robotic device enters via the portholes.”

The robotic arms provide extra movement and manipulation during the procedure. “The less movement inside a patient’s body, the less pain there will be post-surgery and the faster recovery times will be,” Catarino added. The three-dimensional visualization also is a benefit to surgeons using robotic surgery during transplants.

“You can see the airway and blood vessels in ways that are unparalled. The high-definition, 3-D technology showcases details you would never see normally,” Emerson explained.

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