Newswise — Cardiothoracic surgeons in the Smidt Heart Institute at Cedars-Sinai recently performed a groundbreaking robotic-assisted lung transplant.
With a new right lung, the patient, a 69-year-old man from Claremont, California, is back to exercising and chasing his grandchildren after eight years of declining health and mobility as well as breathing difficulties.
“We believe robotic-assisted surgery is the future of lung transplantation,” said Dominic Emerson, MD, the lead surgeon and associate surgical director of Heart Transplant and Mechanical Circulatory Support in the Smidt Heart Institute. “Over the past two years, we have transitioned from offering traditional lung transplantation to minimally invasive lung transplantation to now, robotic-assisted capabilities. This long-awaited achievement is the start of a new era of cardiothoracic care.”
Prior to pioneering the world’s first robotically assisted lung transplant, surgeons in the Smidt Heart Institute also developed new, minimally invasive techniques that speed healing and shorten hospital stays.
“Our team pioneered the utilization of smaller incisions for lung transplant, so much so that most incisions are no bigger than the short side of a driver’s license,” said Emerson, an assistant professor of cardiac surgery. “Smaller incisions reduce postoperative pain and improve recovery for our patients.”
Unlike routine lung transplantations, where surgeons usually create a “clamshell” incision which involves cutting apart the breastbone, the Smidt Heart Institute developed a technique requiring only a small incision between the ribs—just large enough to remove a patient’s old, deflated lungs and then, insert and inflate the new donor lungs.
In addition to this technique, during the robotic lung transplant, surgeons used the robotic device to enter the body via two small “portholes” on the side of the body. These small portholes are utilized during all lung transplant surgeries to place chest drains at the end of surgery, which are later removed.
“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 in the Smidt Heart Institute. “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.”
Catarino, widely recognized as an expert in minimally invasive lung transplantation techniques, scrubbed in alongside Emerson and Dominick Megna, MD, surgical director of the Lung Transplant Program at Cedars-Sinai, to perform the robotic surgery.
The robotic arms, Catarino said, allow for a great deal of movement and manipulation.
“The less movement inside a patient’s body, the less pain there will be post-surgery and the faster recovery times will be,” said Catarino.
In addition to less pain and recovery time for a patient, the robotic procedure has its perks for surgeons, too.
“The visualization used with the robotic device is just so good,” said Emerson. “You can see the airway and blood vessels in ways that are unparalleled. The high-definition, 3-D technology showcases details you would never see normally. It was a remarkable experience—something I will always remember.”
Joanna Chikwe, MD, founding chair of the Department of Cardiac Surgery, noted that the new methods allow the team to help more patients. In 2020, the team performed 18 lung transplants. In 2021, they completed 60.
“Smaller incisions and better visualization lead to better outcomes in the right patients,” said Chikwe. “In addition to surgical advances, we have several research opportunities in the pipeline and plan on big changes in the coming year—changes that will improve every aspect of transplantation for patients.”
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