Lung Nodule Evaluation Using Robotic-Assisted Bronchoscopy at a Veteran’s Affairs Hospital

Abstract

The incidence of lung nodules has increased with improved diagnostic imaging and screening protocols. Despite improvements for diagnosing pulmonary nodules with technologies such as electromagnetic navigational bronchoscopy (ENB), several limitations still exist including adequate visualization, localization, and diagnostic yield. Robotic-assisted bronchoscopy with ENB has been introduced as a method to overcome these shortcomings. We describe our initial experience in evaluating lung nodules with robotic assisted bronchoscopy. We retrospectively reviewed data on the first 25 patients that underwent robotic-assisted bronchoscopy and biopsy. We analyzed success with localization, diagnostic yield, and post procedural morbidity. Diagnostic yield was 96% (24/25) with no periprocedural morbidity. The majority of nodules were malignant or atypical (76%) and were located in the right upper lobe. Diameter ranged between 0.8–6.9 cm (median size 1–2 cm). Seventy-five percent of patients underwent subsequent treatment for cancer based on these results, with 25% having continued surveillance. Robotic assisted bronchoscopy is safe and accurate. Studies with larger numbers will allow better understanding of the diagnostic yield and clinical utility of this approach in comparison to other diagnostic tools for lung nodules.

Robotic‐assisted bronchoscopy versus CT‐guided transthoracic biopsy for diagnosis of pulmonary nodules

“…In addition, diagnostic sensitivity for malignancy with RAB was 82.1% in 113 patients, similar to that reported by Ost et al of 84% in 69 patients and by Fielding et al of 88% in 29 subjects 27,30 . Although a diagnostic yield of 96% was achieved in a single center study consisting of 25 patients, sensitivity for malignant disease was considerably lower at 60% 31 . Compared to CTTB, with sensitivity for malignancy of 85.6%, there was no significant difference in the diagnostic performance between the two procedures.…”

“…To our knowledge, this is the first human‐based study directly comparing RAB to CTTB 31 . Han et al performed a meta‐analysis and systematic review of virtual navigational bronchoscopy versus CT‐guided transthoracic needle biopsy for diagnosis of small pulmonary lesions.…”

A Review of Robotic-Assisted Bronchoscopy Platforms in the Sampling of Peripheral Pulmonary Lesions

“…As the new technology makes its way into hospitals and more single-center experiences are reported [ 30 , 36 ], the body of literature to characterize the performance of these platforms grows. With broader adoption and higher-powered literature on the horizon, it remains to be seen if these technologic advantages will bear improved sensitivities in the biopsy of peripheral pulmonary lesions.…”

State of the Art in Lung Nodule Localization

“…The Monarch (Auris Health, Inc., Redwood City, California) system’s display shows the real-world bronchoscope camera output. A graphical overlay consisting of an arrow/arc on the edge of the camera output informs the user of the articulation of the scope and sheath [ 16 ]. Similarly, the Ion (Intuitive Surgical, Sunnyvale, California) system displays a graphical overlay of a virtual model of the nodule on a fluoroscopy X-ray image in real time, allowing the user to direct the scope towards that nodule [ 17 ].…”