Emerson Dominic, Megna Dominick, Razavi Allen A, DiChiacchio Laura, Malas Jad, Rampolla Reinaldo, Chikwe Joanna, Catarino Pedro
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Ann Thorac Surg. 2025 May;119(5):1107-1116. doi: 10.1016/j.athoracsur.2025.03.005. Epub 2025 Mar 19.
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.
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).
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.
This experience with robotic lung transplantation suggests it is associated with midterm outcomes similar to nonrobotic lung transplantation, despite longer ischemic times.
肺移植通过蚌式切口或胸骨切开术进行，这可能导致发病率增加并限制患者的入选资格。机器人辅助肺移植提供了一种侵入性较小的替代方法，但指导治疗选择的数据有限。因此，本研究旨在评估机器人辅助和微创肺移植的中期结果。
2021年10月至2025年2月连续接受机器人辅助或微创肺移植（定义为小切口开胸<6 cm）的患者被纳入前瞻性登记研究。主要终点是1年生存率。采用线性混合效应回归模型比较术后肺功能。中位随访时间为1.8年（四分位间距，1 - 4年）。
在研究期间，单一中心共进行了209例肺移植，其中111例（53.1%）为微创（21例为机器人辅助[10%]，90例为非机器人辅助[43.1%]）。3例患者从机器人辅助手术转为非机器人辅助手术。与非机器人辅助的微创受者相比，机器人辅助组的危险因素和肺分配评分相似，但中位等待名单时间更长（50天对22.5天，P = 0.02），平均缺血时间分别为486分钟对406分钟（P = 0.02）。机器人辅助组与非机器人辅助的微创受者相比，术后<48小时的呼吸机支持（76.2%对75.6%，P = 0.79）、早期严重原发性移植功能障碍（4.8%对8.9%，P = 0.53）、住院时间（14.1天对14.3天，P = 0.95）、术后肺功能或1年未调整生存率（95.0%对95.5%，对数秩检验P = 0.84）均无显著差异。
这项机器人辅助肺移植经验表明，尽管缺血时间较长，但中期结果与非机器人辅助肺移植相似。
