The Operating Theatre Journal - Journal - Page 16
Vall d’Hebron achieves the first fully robotic
lung transplant with a new access route
For the first time in surgical history, a group of professionals has conducted the procedure only by endoscopy.
The use of robotic surgery has allowed
replacing the traditional 30-centimetre
incision in the thorax with small incisions
measuring just a few centimetres.
Vall d’Hebron University Hospital achieves
a double milestone in the field of lung
transplants. For the first time ever, a lung
has been transplanted using a minimally
invasive technique that entails the use of
robotic surgery. Also, a new access route
has been created through which diseased
lungs can be removed and the new lungs can
be inserted. The new access route, which
requires a mere eight-centimetre incision,
was made in the lower part of the sternum,
just above the diaphragm. This means it is
no longer necessary to make a large opening
by separating the ribs and opening up the
thorax, which was the only available option
until now. This pioneering procedure, which
was performed on a 65 year-old man requiring
a lung transplant due to pulmonary fibrosis,
was carried out as part of a multidisciplinary
intervention involving professionals from
the Thoracic Surgery and Lung Transplants
Department, the Anaesthesia, Resuscitation
and Pain Management Department, the
Cardiac Surgery Department and the
Transplant Nursing Department.
Lung transplantation consists of replacing one
or both diseased lungs with healthy ones. In
general, this happens when there is a disease
that involves severe and progressive chronic
respiratory failure. Lung transplants began
in 1981 in California. In Catalonia, this kind
of procedure is carried out exclusively at the
Vall d’Hebron University Hospital for both
children and adults.
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Since the program began, more than 1,556
lung transplants have been carried out at Vall
d’Hebron.
“Today we are proud to present a pioneering
technique carried out by the Catalan HealthCare System that contributes to the clinical
improvement of all patients internationally”
says Manel Balcells, Minister of Health of
Catalonia. “We present a new technique in
lung surgery that represents an international
and global advance.
We do it together with Xavier, the first
patient transplanted with robotic surgery
and with a new, less invasive access route
that allows a faster recovery”. Manel Balcells
also states that Vall d’Hebron “is a reference
center in lung transplantation for 10 million
people: Catalonia, Aragon and the Balearic
Islands.
As a Public Health-Care system, we
offer new techniques in global clinical
practices that improve the well-being of
all patients”.
“The main problem with opening up the
thorax in lung transplant procedures is that it
is a very aggressive approach which leads to a
very delicate post-operative period”, explains
Dr Albert Jauregui, head of the Thoracic
Surgery and Lung Transplants Department
at Vall d’Hebron University Hospital. In any
transplant procedure, in order to prevent
rejection of the new organ(s), medication
must be administered that depresses the
patient’s immune system for the rest of
their life. This means that the risk of postoperative infection is always very high.
THE OPERATING THEATRE JOURNAL
In some cases, infection eventually occurs
and the wound does not properly close (when
both lungs are transplanted, the incision is
about 30 centimetres-long, running from one
side of the chest to the other). When the
wound does not close due to the presence of
an infection, it is necessary to re-operate to
bring the infection under control.
We must also note that patients in need of
a lung transplant have chronic respiratory
insufficiencies, and that simple actions such
as going to the toilet can be exhausting for
these individuals. Aggressive surgeries, such
as traditional lung transplants, can therefore
entail many negative consequences. But now,
the paradigm has shifted:
“This novel surgical technique allows
us to cut a small section of skin, fat
and muscle, leaving a wound that
closes easily. Not only is this much
safer than the traditional method,
but for this first patient it has been
virtually painless. This is a historic
milestone which we believe will
improve the lives of thousands of
patients”, stated Dr Albert Jauregui.
The professionals of Vall d’Hebron University
Hospital’s Thoracic Surgery and Lung
Transplants Department had been planning to
introduce robotic surgery to lung transplants
for some time. This innovation had only been
used once before, although in a less ambitious
procedure, at the Cedars-Sinai Hospital in Los
Angeles, USA.
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