Robot-Assisted Bronchoscopy for Pulmonary Lesion Diagnosis: Results from the Initial Multicenter Experience

Chaddha, Udit; Kovacs, Stephen P.; Manley, Christopher; Hogarth, D. Kyle; Cumbo-Nacheli, Gustavo; Bhavani, Sivasubramanium V.; Kumar, Rohit; Shende, Manisha; Εgan, John; Murgu, Septimiu

doi:10.21203/rs.2.16572/v2

Cited by 29 publications

(45 citation statements)

References 7 publications

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“…From radial-probe EBUS to electromagnetic navigation (EMN) bronchoscopy, access to peripheral pulmonary nodules via bronchoscopy has continued to improve [90]. The newest iteration of image-guided bronchoscopy is robotic bronchoscopy, where platforms that combine advanced imaging guidance techniques with automated scopes capable of reaching the periphery of the lungs are used to access lesions previously deemed out of reach of conventional bronchoscopic techniques [91]. Initial feasibility studies are promising, even when compared to advanced techniques such as EMN bronchoscopy [91][92][93][94].…”

Section: Future Directionsmentioning

confidence: 99%

“…The newest iteration of image-guided bronchoscopy is robotic bronchoscopy, where platforms that combine advanced imaging guidance techniques with automated scopes capable of reaching the periphery of the lungs are used to access lesions previously deemed out of reach of conventional bronchoscopic techniques [91]. Initial feasibility studies are promising, even when compared to advanced techniques such as EMN bronchoscopy [91][92][93][94]. Robotic and EMN bronchoscopy have traditionally been employed as diagnostic modalities, but great interest exists in leveraging these technologies to apply therapeutic modalities for patients with peripheral nodules who cannot undergo surgical resection.…”

Section: Future Directionsmentioning

confidence: 99%

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Bronchoscopic treatment of inoperable nonsmall cell lung cancer

Kniese

Musani

2020

Eur Respir Rev

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Patients with unresectable lung cancer range from those with early-stage or pre-invasive disease with comorbidities that preclude surgery to those with advanced stage disease in whom surgery is contraindicated. In such cases, a multidisciplinary approach to treatment is warranted, and may involve medical specialties including medical oncology, radiation oncology and interventional pulmonology. In this article we review bronchoscopic approaches to surgically unresectable lung cancer, including photodynamic therapy, brachytherapy, endoscopic ablation techniques and airway stenting. Current and past literature is reviewed to provide an overview of the topic, including a highlight of potential emerging approaches.

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Section: Future Directionsmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

Bronchoscopic treatment of inoperable nonsmall cell lung cancer

Kniese

Musani

2020

Eur Respir Rev

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“…7,8 Presently, very few data exist regarding the use of a robotic endoscopic system in live human subjects with peripheral lesions in need of biopsy. 9,10 This study was performed to assess the feasibility of performing robotic bronchoscopy to locate peripheral lesions in patients and to evaluate the safety and performance characteristics of procedures in a multicenter, prospective trial.…”

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confidence: 99%

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Chen

Pastis

Mahajan

et al. 2021

Chest

173

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BACKGROUND: The diagnosis of peripheral pulmonary lesions (PPL) continues to present clinical challenges. Despite extensive experience with guided bronchoscopy, the diagnostic yield has not improved significantly. Robotic-assisted bronchoscopic platforms have been developed potentially to improve the diagnostic yield for PPL. Presently, limited data exist that evaluate the performance of robotic systems in live human subjects. RESEARCH QUESTION: What is the safety and feasibility of robotic-assisted bronchoscopy in patients with PPLs? STUDY DESIGN AND METHODS: This was a prospective, multicenter pilot and feasibility study that used a robotic bronchoscopic system with a mother-daughter configuration in patients with PPL 1 to 5 cm in size. The primary end points were successful lesion localization with the use of radial probe endobronchial ultrasound (R-EBUS) imaging and incidence of procedure related adverse events. Robotic bronchoscopy was performed in patients with the use of direct visualization, electromagnetic navigation, and fluoroscopy. After the use of R-EBUS imaging, transbronchial needle aspiration was performed. Rapid on-site evaluation (ROSE) was used on all cases. Transbronchial needle aspiration alone was sufficient when ROSE was diagnostic; when ROSE was not diagnostic, transbronchial biopsy was performed with the use of the robotic platform, followed by conventional guided bronchoscopic approaches at the discretion of the investigator. RESULTS: Fifty-five patients were enrolled at five centers. One patient withdrew consent, which left 54 patients for data analysis. Median lesion size was 23 mm (interquartile range, 15 to 29 mm). R-EBUS images were available in 53 of 54 cases. Lesion localization was successful in 51 of 53 patients (96.2%). Pneumothorax was reported in two of 54 of the cases (3.7%); tube thoracostomy was required in one of the cases (1.9 %). No additional adverse events occurred. INTERPRETATION: This is the first, prospective, multicenter study of robotic bronchoscopy in patients with PPLs. Successful lesion localization was achieved in 96.2% of cases, with an adverse event rate comparable with conventional bronchoscopic procedures. Additional large prospective studies are warranted to evaluate procedure characteristics, such as diagnostic yield.

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“…First, it was designed to focus solely on the interpretation of ultra-low-dose CT scans by radiologists and pulmonary physicians. Novel navigation modalities for bronchoscopy (e.g., virtual bronchoscopy navigation and electromagnetic navigation bronchoscopy) have been widely used to diagnose peripheral lung lesions under the guidance of artificial intelligence [ 19 , 20 , 21 ]. Therefore, bronchoscopy for peripheral lung lesions that depends solely on the interpretation of a CT scan by a doctor may be regarded as an outdated method.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Ultra-Low-Dose CT for Bronchoscopy of Peripheral Lung Lesions

et al. 2020

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Background and objectives: Thin-section computed tomography (CT) is essential for identifying small bronchi during bronchoscopy using radial endobronchial ultrasound. Some patients should receive an additional CT for a thin-section image. We performed a retrospective study with a prospectively collected database to identify the optimal radiation dose for thin-section CT during peripheral bronchoscopy. Materials and Methods: In total, 91 patients with peripheral lung lesions underwent thin-section CT (both standard CT as a reference and ultra-low-dose CT (ultra-LDCT)). The patients were randomly assigned to one of four groups according to the ultra-LDCT parameters: group 1 = 120 kVp, 25 mAs; group 2 = 100 kVp, 15 mAs; group 3 = 120 kVp, 5 mAs; and group 4 = 100 kVp, 5 mAs. Two radiologists and two physicians analyzed both the standard CT and ultra-LDCT. Results: The effective doses (EDs) of ultra-LDCT significantly differed among the four groups (median EDs were 0.88, 0.34, 0.19, and 0.12 mSv for groups 1–4, respectively; p < 0.001). Median differences in peripheral airway wall thickness were higher in group 4 than in other groups (differences in median wall thickness measured by two radiologists were 0.4–0.5 mm and 0.8–0.9 mm for groups 1–3 and group 4, respectively). Bronchus signs on ultra-LDCT in groups 1 and 2 were well correlated with those of the standard-dose CT (accuracies of two radiologists and two pulmonary physicians were 95–100%). Conclusions: Our results indicate that ultra-LDCT with ED of >0.34 mSv (ED of group 2) is feasible for peripheral bronchoscopy.

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Robot-Assisted Bronchoscopy for Pulmonary Lesion Diagnosis: Results from the Initial Multicenter Experience

Cited by 29 publications

References 7 publications

Bronchoscopic treatment of inoperable nonsmall cell lung cancer

Bronchoscopic treatment of inoperable nonsmall cell lung cancer

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Feasibility of Ultra-Low-Dose CT for Bronchoscopy of Peripheral Lung Lesions

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