Pope Leo XIV underwent lung surgery on Tuesday at Rome’s Gemelli Hospital, during which he was under general anesthesia for approximately 90 minutes. His temporary unconsciousness prompted questions about the Catholic Church’s governance during periods when the pontiff is incapacitated. However, the Vatican has no specific protocols for such circumstances beyond established procedures that apply when a pope dies, resigns, or is otherwise unable to govern freely.
The Vatican’s administrative operations continue uninterrupted even during the pope’s hospitalization, a system familiar from the extended medical treatments of previous popes such as John Paul II and Pope Francis. The Gemelli Hospital has long provided a dedicated suite for papal care, which Leo XIV is currently not using as it undergoes renovations, instead being accommodated in nearby hospital rooms.
No deputy assumes papal authority during periods of incapacitation, and important decisions or appointments can be communicated to the pope while he remains hospitalized, according to church experts. Officials responsible for the Vatican’s day-to-day management include the secretary of state, Cardinal Piero Parolin, who alongside other senior staff maintain the Holy See’s functions across its various offices and departments, which oversee areas such as evangelization, clergy affairs, education, and finances.
The pope’s medical team reported on Thursday that his recovery is progressing as expected. A chest X-ray showed the lung is healing well, and the pope has been able to carry out daily activities independently. Vatican sources noted that Leo XIV celebrated Mass at the hospital and resumed work, albeit at a reduced pace.
The church’s governance structure is designed to function continuously even amid delays or the temporary slowdown of the pope’s ability to perform his duties. Canonical experts highlight that centuries of legal and administrative development provide resilience within the Vatican’s “deep state,” preventing a governance crisis solely due to the pope’s illness.
The issue of papal incapacitation has gained attention in recent decades, particularly during John Paul II’s prolonged illness and Benedict XVI’s 2013 resignation citing health concerns. Pope Leo XIV announced last Sunday that a growth was found on his lung during routine examinations, prompting surgical intervention two days later. The Vatican has not provided details on when the lung nodule was initially detected.
Following the surgery, Vatican officials noted that histological examination of the tumor would take time. Pope Leo XIV continues to hope for a planned visit to South America next month.
In the lead-up to his surgery, observers noted the pope's recent appointments, which some interpret as efforts to reinforce Vatican leadership ahead of his recovery. These include the designation of Cardinal Luis Antonio Tagle as dean of the College of Cardinals, a key role during any future papal transition, and the appointment of Archbishop Vittorio Viola as Archpriest of St. Peter’s Basilica and Vicar General of Vatican City—positions that retain continuity even in the event of a papal vacancy.