The expanding use of robotic technology in lung transplantation came under scrutiny at today’s 46th Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation (ISHLT), where experts debated whether its clinical benefits justify the cost and complexity.
Stephanie Chang, MD, Thoracic and Transplant Surgeon at NYU Langone Health, who supports robotics, and Hermann Reichenspurner, MD, PhD, retired surgeon and pioneer in minimally invasive cardiothoracic surgery, joined the discussion, presenting the counterpoint.
Robotic-assisted thoracic surgery may expand the patient pool
Dr. Chang highlighted the potential of robotic-assisted surgery to improve recovery and expand access to transplantation.
“Robotic, minimally invasive approaches can reduce the physiological stress of transplantation compared to traditional, large access incisions,” he said.
Dr. Chang noted that in lung transplantation, robotic techniques offer:
- smaller incisions and improved visualization
- less bleeding and less hemodynamic shifts
- potential reductions in kidney injury, pain and hospital stay.
“As robotic techniques become faster and more widely adopted, frailer and older patients may become transplant candidates,” he said.
In contrast, Dr. Reichenspurner emphasized that current evidence does not demonstrate superior patient outcomes with robotic approaches compared with established minimally invasive techniques.
“There is not a single comparative study that shows a significant advantage of robotic systems in terms of survival, morbidity or length of stay,” he said. “The results are comparable, but not better.”
Dr. Reichenspurner, who has performed about 450 heart transplants and is a past president of the ISHLT, was an early adopter of robotic and minimally invasive heart surgery in the late 1990s. He emphasized that his position reflects experience, not resistance to innovation.
“This is not about being conservative,” he said. “It’s about determining whether the added cost and complexity is justified by a measurable benefit.”
Do the costs justify the use?
He pointed out several limitations of robotic systems, including:
- high upfront and maintenance costs
- limited patient access to centers that offer robotic capabilities
- lack of randomized controlled trials to support the adoption of international guidelines.
Dr. Reichenspurner also expressed concerns that robotics can sometimes function more as a competitive marketing tool than a clinically necessary development. At the same time, Dr. Reichenspurner identified specific advantages of robotic systems, including surgical training.
“Surgical robots are more accurately described as teleoperated, surgeon-controlled systems that enhance precision but do not operate independently,” he said. “With these systems, both the learner and the instructor can work simultaneously, which is a clear benefit to training.”
The discussion also highlighted important distinctions in how robotics is applied across medical specialties. While robotic systems are widely used in thoracic surgery and fields such as urology and gynecology, their role in heart transplantation remains extremely limited.
“To date, robotic heart transplantation is virtually nonexistent,” noted Dr. Reichenspurner. “For a heart transplant, a large incision is required anyway, which limits the use of robotics.”
The need for controlled, randomized trials
While both speakers agreed that the use of robotics in lung transplants is likely to increase, particularly at centers that already use the technology for other thoracic procedures, widespread adoption will likely depend on stronger clinical evidence.
“For the use of robotics to become part of official guidelines, we need randomized trials comparing its outcomes with minimally invasive surgery,” said Dr. Reichenspurner.
The ISHLT Annual Meeting and Scientific Sessions are being held April 22-25 at the Metro Toronto Convention Center in Toronto, ON, Canada.
