Intraprocedural O-arm Computed Tomography guided Navigation with Ventilatory Strategy for Atelectasis Electromagnetic Navigation Bronchoscopic Biopsy of Peripheral Lung Lesions: an IDEAL stage 2a study

Abstract

Background: To improve the accuracy of electromagnetic navigation bronchoscopy (ENB) in the diagnosis of pulmonary nodules, we developed an innovative method to modify ENB, which first combines Intraprocedural Computed tomography (CT) guided navigation with Ventilatory strategy for Atelectasis (ICNVA). Methods: This was a retrospective single-institution study in alignment with the IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) 's prescribed developmental stages 2a. Patients who planned to undergo ENB for pulmonary lesion biopsy were invited to participate. For each patient, we do not use preoperative chest CT data in the conventional ENB approach for navigation planning. Instead, after endotracheal intubation under general anesthesia and bronchoscope insertion into the endotracheal tube, we used O-arm CT scanner in the hybrid operating room to acquire intraoperative CT data for ENB path planning. Following endotracheal intubation under general anesthesia, a ventilation strategy to prevent lung collapse is employed to reduce the occurrence of atelectasis. Moreover, the same ventilation parameters were used when intraoperative CT data was acquired and ENB procedures was performed to minimize computed tomography to body divergence (CTBD) to the greatest extent possible. 50 consecutive participants completed this study beginning in March 2022. We have iteratively adjusted the technology. In accordance with the IDEAL recommendations, we recorded the technological modifications and general characteristics of each patient and ENB related data. Results: All patients completed biopsy successfully. 2 patients developed pneumothorax, and 2 patients experienced bleeding but did not require surgical treatment. Four deliberate changes in technique occurred. After the first technological modification, ENB related security improved. After starting to establish puncture tunneling by using Wang's needle (MW-319), the ENB accuracy was significantly improved. After the CT scan area was reduced, the radiation dose to patients was reduced. Conclusions: ICNVA-ENB has early indications for safety and efficacy in the biopsy of peripheral lung lesions.