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Robotic-assisted Lung Transplantation: A Meta-analysis Of Early Outcomes In Minimally Invasive Transplant Surgery
Bilal Khan Mohammed, Aqsa Muskaan, Stephen Chiu, Samul Kim, Ankit Bharat.
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
BACKGROUND:Lung transplantation remains among the most invasive procedures in cardiothoracic surgery, with thoracotomy- or clamshell-based approaches contributing to postoperative pain, prolonged recovery, and morbidity. Recent advances in robotic thoracic surgery have enabled the first clinical applications of robotic-assisted lung transplantation (RALTx). However, evidence supporting this approach remains limited. We performed a systematic review and meta-analysis to evaluate the feasibility and early outcomes of RALTx and to test the hypothesis that robotic transplantation achieves comparable graft outcomes without increased perioperative risk.
METHODS:A systematic review was conducted according to PRISMA guidelines to identify all published reports of robotic-assisted lung transplantation through December 2025. Studies reporting perioperative outcomes were included. Pooled analyses were performed using available comparative data between robotic-assisted and non-robotic minimally invasive lung transplantation. Primary outcomes were 30-day mortality and severe primary graft dysfunction (PGD grade ≥3). Secondary outcomes included ventilator duration, hospital length of stay, and perioperative complications. Categorical variables were compared using Fisher"s exact test and continuous variables using two-sample t-tests. Statistical significance was defined as
P < 0.05.
RESULTS:Seven studies comprising 30 robotic-assisted lung transplant recipients were identified. Comparative outcome data were available from a high-volume institutional cohort including 21 robotic-assisted and 90 non-robotic minimally invasive lung transplants. One-year survival was not significantly different between robotic and non-robotic approaches (95.0% vs. 95.5%,
P = 0.84). Rates of severe PGD were low and comparable between groups (4.8% vs. 8.9%,
P = 0.53). Median ventilator duration did not differ significantly (robotic 1.8 ± 0.6 days vs. non-robotic 1.9 ± 0.7 days,
P = 0.79), nor did hospital length of stay (14.1 ± 3.2 vs. 14.3 ± 3.5 days,
P = 0.95). Robotic-assisted cases demonstrated longer operative and ischemic times (ischemic time 486 ± 62 vs. 406 ± 55 minutes,
P = 0.02); however, this did not translate into increased PGD, mortality, or early graft failure. Across all reported robotic cases, no conversions to open surgery or technique-specific graft complications were observed. Early institutional experiences, including the first robotic lung transplantation performed in Illinois, further demonstrate procedural reproducibility in experienced centers.
CONCLUSIONS:Robotic-assisted lung transplantation is feasible and demonstrates early survival and graft outcomes comparable to established minimally invasive approaches. Although associated with longer operative and ischemic times, robotic transplantation does not increase early mortality, graft dysfunction, or length of hospitalization. These findings support the hypothesis that robotic platforms may enable a less invasive lung transplantation paradigm without compromising clinical outcomes. Prospective multicenter studies are needed to define long-term benefit, patient selection, and learning curve effects.
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