The Spanish doctor explained that lung transplants are aggressive surgeries because they force an incision across most of the chest and break the ribs, in order to reach the organs. To try to avoid this situation, the experts of the Vall d’Hebron hospital have created “a new minimally invasive technique, in order not to open the chest or the sternum as if it were the hood of the car,” Jauregui explained.
This new technique consists of making “a small incision under the breastbone, without breaking the ribs, through which the lung enters and exits,” he explained. In addition, even smaller incisions are made on the side of the rib cage to enter the arms and 3D cameras of the da Vinci surgical robot, with which the surgeon works to remove and insert organs using the opening under the breastbone.
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To introduce the new lung, the specialists “deflated” the organ in the operating room to allow it to enter through the small incision under the breastbone, in a point on the body that has the advantage of having “very elastic” skin, which gives room to widen the opening, albeit “without having to touch a rib,” Jauregui stressed.
This innovative intervention was carried out at the end of February at the Vall d’Hebron Hospital and lasted about 5 hours. The operated patient, named Xavier, 65, had pulmonary fibrosis diagnosed in 2007.
Having recovered from the operation, the patient thanked the donor’s family, without which he would not have been able to enjoy “this advantage” of being able to be transplanted. Having worked as an industrial electrician, surrounded by machines, the patient admitted that he has no qualms about agreeing to undergo an operation with a robot, because he is aware that he can “avoid the risks of human error”.
Although he still has some recovery work, Xavier said he was “delighted” with the result, as during the post-op period “the pain level was zero”.
Transplant recipients take lifelong medication to control rejection of the new organ and this complicates recovery from surgery, but because the incisions in this case were small, Xavier only required paracetamol after surgery when in a conventional transplant, opioid drugs are administered to the lung, i.e. much more powerful painkillers.
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This new technique not only reduces postoperative pain, but also advances pulmonary rehabilitation and has the potential to reduce intensive care unit (ICU) days.
Examples of advances in robotic surgery are numerous. Among them, for example, in 2021, in Argentina, a 73-year-old patient diagnosed with prostate cancer and bilateral inguinal hernia, with a slipped bladder on one side and visceral hernia on the other, underwent a single operation articulate with the help of a robot.
As in the Spanish case, the man had a shorter and less painful postoperative period than usual and with fewer adverse events. The surgery was carried out at the Otamendi sanatorium in the city of Buenos Aires and lasted seven hours. It involved the participation of two surgeons, two urologists, two bioengineers, an anesthetist, a cardiologist and a team of two surgical instrumentalists. For this operation, the Da Vinci XI robot was used for the first time.
