The Vall d’Hebron hospital has implemented an innovation of global scope. The specialists at the Barcelona center have performed the first fully robotic lung transplant in the world and have also created a new access route to remove damaged organs and insert new lungs. “We consider it a historic milestone because it will lead to an improvement in the quality of life of many patients”, said Albert Jauregui, author of the pioneering intervention and head of the thoracic surgery and lung transplant service.
More precision, less risk and a much less complicated postoperative period. There will be a before and after in the lung transplant since the pioneering surgery done at the end of March on Xavier, a 65-year-old man who needed a new lung due to pulmonary fibrosis. The Minister of Health, Manel Balcells, pointed out that the Vall d’Hebron is consolidating itself as a national and global benchmark in lung transplantation, for having played the role of the most significant advance since in 1990 it performed the first successful lung transplant in Spain Last year, 415 were performed, a quarter of which (107) at Vall d’Hebron, the most experienced center and the one that has been pursuing the introduction of robotic surgery for years.
Specialists accessed the cavity through the lower part of the sternum, through an 8-centimeter incision just above the diaphragm. The traditional system, the only one available so far, consists of a large horizontal opening of 30 cm in the thorax to handle the organs to be extracted and implanted between the ribs. “The big problem with opening the chest is that it is a very aggressive approach with a very delicate postoperative period,” Jauregui explained. In this sense, the immunosuppressive medication that the patient must receive for life to avoid rejection increases the risk of postoperative infection. And if an infection occurs in the large 30 cm wound, it is necessary to operate again in order to control it.
Much less aggressive, “the new technique allows us to cut only a small section of skin, fat and muscles, a wound that heals easily, much safer and that in this first patient has produced practically no pain”, explained Jauregui. Vall d’Hebron has worked for some time to reduce the aggressiveness of lung transplantation, but always ended up running into the lack of an alternative way to extract and insert the organs. He went to Dr. Iñigo Royo, who came up with the idea of ​​exploring subxiphoid surgery, an access route that has been used for a few years to operate on early-stage lung and thymus cancer. The xiphoid is the cartilage found at the lower end of the sternum. A manual 8 cm incision in the skin below the xiphoid and above the diaphragm, with a spacer to maintain the orifice, was sufficient for passage of the lung. (And it will be when, in a few months, according to Jauregui’s estimates, a second organ enters the first bipulmonary robotic transplant).
From here the intervention was completely robotic, with four arms of the Da Vinci robot inserted into the thorax and manipulated by the surgeon from a console. A lever guides the arm that separates the heart so that it does not hinder the maneuver in and out of the lungs. Two other arms control surgical tools such as scalpels and forceps. The latter incorporates a camera that allows you to see the inside of the body in 3D through monitors.
The diseased lung was removed through the subxiphoid wound and the new one was inserted through the same incision, sewn to the body using the robotic limbs. “A before and an after in the history of lung transplants”, celebrates the Vall d’Hebron. The only precedent that comes close to this milestone refers us to the USA, at the Cedars-Sinai hospital in Los Angeles. Last year, this center used robotic surgery for the first time in a final phase of the procedure, when suturing the new lung to the airway and great vessels. The rest of the intervention, including the introduction of the organ between the ribs, was practiced in the traditional way.
The new lung struggled to stabilize and Xavier was connected to automatic respiration (ECMO) and spent more time in the hospital than usual. Things about the transplant, nothing to do with the new approach, according to the intensive care service. So it stabilized, the recovery “was very quick and painless”, according to the patient, who hesitated little: “You play it, but I knew there was a team here and I said: ‘go ahead'”. “All my life working as an industrial electrician surrounded by machines and robots. For me it is no problem, I know that what they do is to improve human performance and perfect the work.
