Robotic Lung Transplantation: Feasibility, Initial Experience, and 3-Year Outcomes

Background: Lung transplantation is performed through clamshell or sternotomy incisions, which may contribute to morbidity and limit patient eligibility. Robotic lung transplantation offers a less-invasive alternative, but data informing treatment choice are limited. This study was therefore designed to evaluate midterm outcomes of robotic and minimally invasive lung transplantation. Methods: Consecutive patients undergoing robotic or minimally invasive lung transplant (defined by <6-cm minithoracotomy) from October 2021 to February 2025 were included in a prospective registry. The primary end point was 1-year survival. A linear mixed-effects regression model compared postoperative pulmonary function. Median follow-up time was 1.8 years (interquartile range, 1-4 years). Results: During the study period, 209 lung transplants, including 111 (53.1%) minimally invasive (21 robotic [10%] and 90 nonrobotic [43.1%]), were performed at a single center. Three patients were converted from robotic to nonrobotic approaches. The robotic cohort had similar risk factors and lung allocation scores but longer median waiting list times (50 days vs 22.5 days, P = .02) compared with nonrobotic minimally invasive recipients, and mean ischemic time was 486 minutes vs 406 minutes (P = .02), respectively. There were no significant differences in postoperative ventilator support <48 hours (76.2% vs 75.6%, P = .79), early severe primary graft dysfunction (4.8% vs 8.9%, P = .53), hospital stay (14.1 vs 14.3 days, P = .95), postoperative pulmonary function, or 1-year unadjusted survival (95.0% vs 95.5%, log-rank P = .84) in robotic compared with nonrobotic minimally invasive recipients. Conclusions: This experience with robotic lung transplantation suggests it is associated with midterm outcomes similar to nonrobotic lung transplantation, despite longer ischemic times.