The expanded use of robotic technology in lung transplantation came under scrutiny today at the International Society for Heart and Lung Transplantation (ISHLT)’s 46th Annual Meeting and Scientific Sessions, where experts debated whether its clinical benefits justify the cost and complexity.
In the debate, Dr. Stephanie Chan, a thoracic transplant surgeon at New York University Langone Health, argued in favor of robotics, and Hermann Reichenspruner, M.D., a retired surgeon and pioneer in minimally invasive cardiothoracic surgery, argued against it.
Robot-assisted thoracic surgery could expand patient population
Dr. Chang highlighted the potential of robot-assisted surgery to improve recovery and expand access to transplants.
“The robotic minimally invasive approach can reduce the physiological stress of implantation compared to traditional large access incisions,” she said.
Dr. Chang said robotic technology has the following benefits in lung transplantation:
- Smaller incisions and improved visualization
- Less bleeding and fewer hemodynamic changes
- Kidney damage, pain, and hospital stay may be reduced.
“As robotic technology becomes faster and more widely adopted, more frail and elderly patients may become candidates for transplants,” she said.
In contrast, Dr. Reichenspurner emphasized that current evidence does not demonstrate superior patient outcomes with robotic approaches compared to established minimally invasive techniques.
“No single comparative study has shown a significant advantage of robotic systems in terms of survival, morbidity, or length of hospital stay,” he said. “The results are similar, but not better.”
Dr. Reichenspruner, who has performed approximately 450 heart transplants and is a past president of ISHLT, was an early adopter of robotic minimally invasive cardiac surgery in the late 1990s. He stressed that his position reflects experience and is not resistance to innovation.
“This is not about being conservative,” he said. “The key is to determine whether the additional cost and complexity is justified by measurable benefits.”
Are the expenses justified by the use?
He pointed out several limitations of the robotic system.
- High initial costs and maintenance costs
- Patient access to centers offering robotic capabilities is limited
- There is a lack of randomized controlled trials to support the adoption of international guidelines.
Dr. Reichenspruner also raised concerns that robotics may serve more as a competitive marketing tool than a clinically necessary advance. At the same time, Dr. Reichenspruner acknowledged the unique benefits of robotic systems, including for surgical training.
“Surgical robots are more accurately described as remote manipulators, which are surgeon-controlled systems that increase precision but do not operate independently,” he said. “These systems allow both trainees and instructors to work at the same time, so there are clear benefits for education.”
The discussion also highlighted important differences in how robotics is applied across medical specialties. Although robotic systems are widely used in fields such as thoracic surgery, urology, and gynecology, their role in heart transplantation is still very limited.
“To date, robotic heart transplantation is essentially non-existent,” Dr. Reichenspruner noted. “For heart transplants, large incisions are required anyway, which limits the use of robots.”
The need for controlled randomized trials
Both speakers agreed that the use of robotics in lung transplantation is likely to expand, especially in institutions that already use robotic technology for other thoracic surgeries, but widespread adoption will likely depend on stronger clinical evidence.
“For the use of robotics to become part of formal guidelines, randomized trials are needed to compare its results with minimally invasive surgery,” Dr. Reichenspruner said.
ISHLT’s annual general meeting and academic sessions will be held from April 22 to 25 at the Metro Toronto Convention Center in Toronto, Ontario, Canada.
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International Heart and Lung Transplant Society
