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Multicenter Study
. 2019 Dec 11;19(1):243.
doi: 10.1186/s12890-019-1010-8.

Robot-assisted bronchoscopy for pulmonary lesion diagnosis: results from the initial multicenter experience

Udit Chaddha  1 , Stephen P Kovacs  2 , Christopher Manley  3 , D Kyle Hogarth  4 , Gustavo Cumbo-Nacheli  5 , Sivasubramanium V Bhavani  4 , Rohit Kumar  3 , Manisha Shende  6 , John P Egan 3rd  5 , Septimiu Murgu  4
Affiliations
Multicenter Study

Robot-assisted bronchoscopy for pulmonary lesion diagnosis: results from the initial multicenter experience

Udit Chaddha et al. BMC Pulm Med. .

Abstract

Background: The Robotic Endoscopic System (Auris Health, Inc., Redwood City, CA) has the potential to overcome several limitations of contemporary guided-bronchoscopic technologies for the diagnosis of lung lesions. Our objective is to report on the initial post-marketing feasibility, safety and diagnostic yield of this technology.

Methods: We retrospectively reviewed data on consecutive cases in which robot-assisted bronchoscopy was used to sample lung lesions at four centers in the US (academic and community) from June 15th, 2018 to December 15th, 2018.

Results: One hundred and sixty-seven lesions in 165 patients were included in the analysis, with an average follow-up of 185 ± 55 days. The average size of target lesions was 25.0 ± 15.0 mm. Seventy-one percent were located in the peripheral third of the lung. Pneumothorax and airway bleeding occurred in 3.6 and 2.4% cases, respectively. Navigation was successful in 88.6% of cases. Tissue samples were successfully obtained in 98.8%. The diagnostic yield estimates ranged from 69.1 to 77% assuming the cases of biopsy-proven inflammation without any follow-up information (N = 13) were non-diagnostic and diagnostic, respectively. The yield was 81.5, 71.7 and 26.9% for concentric, eccentric and absent r-EBUS views, respectively. Diagnostic yield was not affected by lesion size, density, lobar location or centrality.

Conclusions: RAB implementation in community and academic centers is safe and feasible, with an initial diagnostic yield of 69.1-77% in patients with lung lesions that require diagnostic bronchoscopy. Comparative trials with the existing bronchoscopic technologies are needed to determine cost-effectiveness of this technology.

Keywords: Biopsy; Electromagnetic navigation; Lung cancer; Lung lesion; Robotic bronchoscopy.

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Conflict of interest statement

Dr. Murgu has acted as a paid educational consultant for Olympus, Cook Inc., Pinnacle Biologics and Boston Scientific. Dr. Kovacs, Dr. Manley, Dr. Cumbo-Nacheli and Dr. Egan are consultants for Auris and have received consulting fees. Dr. Hogarth has received honoraria for preceptorships, lectures, and consulting from Boston Scientific. He has also received unrestricted education grants from Boston Scientific. He has received honorarium from Biodesix and Veracyte for lectures and consulting. He has received unrestricted education grants from Biodesix. He has been part of contracted research studies for Veracyte. He is a consultant for Auris and also a stock holder. Dr. Chaddha, Dr. Bhavani, Dr. Kumar and Dr. Shende have nothing to declare.

Figures

Fig. 1
Fig. 1
r-EBUS use to enable directional targeting of instruments. With RAB, an endoscopic view is maintained even in the smaller peripheral airways. Upper panel: the r-EBUS probe is in contact with the airway wall at the 11 o’clock position. The corresponding ultrasound image on the right shows only air artifact. Lower Panel: The r-EBUS probe is now directed to the 5 o’clock position of the airway wall and the ultrasound image reveals an eccentric view of the target lesion. An aspirating needle was oriented to penetrate the airway wall at the 5 o’clock position to obtain diagnostic tissue
See this image and copyright information in PMC

References

    1. Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidencebased clinical practice guidelines. Chest. 2013;143(5 Suppl):e142S–e165S. doi: 10.1378/chest.12-2353. - DOI - PubMed
    1. Ost DE, Ernst A, Lei X, et al. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE registry. Am J Respir Crit Care Med. 2016;193(1):68–77. doi: 10.1164/rccm.201507-1332OC. - DOI - PMC - PubMed
    1. Wang Memoli JS, Nietert PJ, Silvestri GA. Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest. 2012;142(2):385–393. doi: 10.1378/chest.11-1764. - DOI - PMC - PubMed
    1. Mehta AC, Hood KL, Schwarz Y, Solomon SB. The evolutional history of electromagnetic navigation bronchoscopy: state of the art. Chest. 2018;154(4):935–947. doi: 10.1016/j.chest.2018.04.029. - DOI - PubMed
    1. Herth FJF, Eberhardt R, Sterman D, Silvestri GA, Hoffmann H, Shah PL. Bronchoscopic transparenchymal nodule access (BTPNA): first in human trial of a novel procedure for sampling solitary pulmonary nodules. Thorax. 2015;70(4):326–332. doi: 10.1136/thoraxjnl-2014-206211. - DOI - PubMed

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