Duke offers multiple robotic technologies for lung transplant, even contributing to the FDA pivotal trial for a new indication. Unlike open surgery, robotic procedures use smaller incisions to insert instruments that guide surgery, for less pain and quicker healing during the patient’s recovery.

Thoracic surgeons Matthew G. Hartwig, MD, and Jacob A. Klapper, MD, surgical director of the Duke Lung Transplant Program, were part of the team that performed Duke’s first fully robotic lung transplant, one of the first in the nation. Lung transplant surgeons Kunal Patel, MD, PhD, and Hiroshi Date, MD, the newest addition to the department, were also involved in the cutting-edge procedure.

The 71-year-old male patient had a history of pulmonary fibrosis. After Duke monitored his condition for four years, he became more symptomatic, and the team listed him for transplant. Like this patient, two-thirds of Duke lung transplant patients are over the age of 65 — a much older patient population than the national average. Duke is among the few programs to consider transplantation as an option for patients over 65 that are higher-risk candidates with end stage lung disease, that may have been declined candidacy at other centers.

The patient was extubated, walking, and eating less than 48 hours postoperation. Just nine days after surgery, he was released to complete therapy in an outpatient setting, which he concluded at the end of March.

The single-port robot is another robotic thoracic surgery option recently approved by the FDA. Rather than multiple intercostal incisions to access the chest as in other robotic surgeries, the single-port robot uses one incision, further decreasing pain and speeding recovery. Duke was among the sites testing the technology for safety to gain FDA approval, giving Duke surgeons more experience with the robot.

“The single-port robot provides better access for many anatomic structures,” says Hartwig. “We’re looking forward to training other thoracic surgeons as the first epicenter for the single-port robot for thoracic surgery in the Southeast.”

Robotic surgery offers advantages to patients and surgeons. “Visualization is improved with the robot,” Klapper says. “It even seems to make it a little easier to sew the new lung in with less trauma. This continues our tradition at Duke of being among the first to do innovative things that advance the field.”

Duke has performed more than 2,500 lung transplants to date, the most of any program in the U.S., with 94 lung transplants in 2024 alone. The faculty also have similarly extensive experience in robotic thoracic surgeries, with Klapper and Hartwig performing over 2,500 robotic procedures.