Scientific milestone: the first lung transplant was performed with a robot without opening the thorax

The ace surgeries which are made using robots They have already spent several years of research and practice in the world, but their development does not stop. One of the last successful experiments was that carried out by Spanish professionals in the Vall d’Hebron Hospital of Barcelona who made the first lung transplant with a completely robotic surgery by a new way, which is a small incision under the sternum where the diseased lung has been removed and the new one inserted, without having to break your chest.

This is a pioneering technique because until now a similar experiment had only been carried out in the New York’s Mount Sinai Hospitalbut it was robotic surgery partielreported today the head of the Thoracic Surgery and Lung Transplantation Service of Vall d’Hebron, Albert Jauregui, for what he considered an international milestone.

During a press conference, the Spanish doctor explained that lung transplants are aggressive surgeries because they force an incision to be made in a large part of the chest and break ribs, in order to reach the organs. To try to avoid this situation, experts from the Vall d’Hebron hospital have created “a new minimally invasive technique, so as not to open the chest or sternum as if it were the bonnet of the car” , said Jauregui.

This new technique consists in carrying out “a small incision under the sternum, without breaking the ribs, where the lung goes in and out,” he explained. In addition, even smaller incisions are made in the side of the rib cage to enter the arms and cameras 3D of da vinci surgical robotwith which the surgeon operates to remove and insert organs using the opening under the sternum.

To insert the new lung, specialists “deflated” the organ in the operating room to allow it to enter through the small incision under the sternum, at a place in the body which has the advantage of having “very elastic” skin, which allows to widen the opening, although “without having to even touch a rib,” Jauregui pointed out.

This innovative intervention was carried out at the end FEBRUARY at Vall d’Hebron Hospital and lasted a few 5 hours. The operated patient, named Xavier, from 65 yearsyes, i had one pulmonary fibrosis diagnosed in 2007. At first, this condition was thought to be caused by smoking, but after quitting smoking, the organ continued to slowly deteriorate until a time came when it was required a transplant, although in his case it was enough that he was a single lung.

Already recovered from this innovative operation, the man had words of gratitude for the donor and his family, without whom he would not have been able to take advantage of “this advantage” of being able to be transplanted. Having worked as an industrial electrician, surrounded by machines, the patient admitted that he had no hesitation in accepting surgery with a robot, because he is aware that he can “avoid the risk of human error”.

Although he still has some recovery work to do, Xavier said he was “delighted” with the result, because during the postoperative period “The pain level has been nil.”

Transplant recipients take lifelong medication to control rejection of the new organ, making it difficult for surgery to heal, but since the incisions in this case were small, Xavier only needed paracetamol after the procedure, when opioid drugs are given in a conventional lung transplant, i.e. much stronger painkillers.

This new technique not only reduces postoperative pain, but also advances respiratory rehabilitation and has the ability to reduce days of intensive care unit (ICU) stay and hospitalization, although it is still early to specify how many days of reduction It would mean compared to conventional transplants, since there has only been a first case, Jauregui pointed out.

The head of the Vall d’Hebron thoracic surgery and lung transplantation department believes that over time this technique could be applied to transplants of both lungs – the same incision under the sternum would suffice, he assured – and that it will be extended to more patients even if for the moment it is still a “very new” surgery, so for now it can only be offered to “highly selected candidates”.

There are many examples of advances in robotic surgery. Among them, for example, in 2021, in Argentina, a 73-year-old patient, diagnosed with Prostate cancer and a bilateral inguinal hernia, with sliding bladder on one side and visceral on the other, was operated on in a single joint operation using a robot.

As in the Spanish case, the man had a shorter and less painful postoperative period than usual and with fewer adverse events. The operation was performed at the Sanatorium Otamendi in the city of Buenos Aires and lasted seven hours. It included the participation of two surgeons, two urologists, two bioengineers, an anesthesiologist, a cardiologist and a team of two surgical instrumentists. For this operation, the Da Vinci XI robot was used for the first time.

But these advances go back much further in time. In 2001the french surgeon Jacques Marescaux, who was in New York, USA, performed a minimally invasive procedure to remove the gallbladder from a 68-year-old patient who was in France. He did this by controlling the arms of the Zeus robot and using a high-speed fiber optic system. It only took 45 minutes.

With information from EFE

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