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.

Keywords: lung cancer; navigational bronchoscopy; robotic bronchoscopy; robotic surgery.

Figure 1

Example of images from the monitor during a robotic bronchoscopy procedure. (A) The left part of the screen shows the bronchoscopic image of the left upper lobe sub-segmental bronchus with endobronchial tumor. The middle images show the generated pathway to the left upper lobe nodule and the right images show the accommodating sagittal, coronal and axial views of the tumor in the left upper lobe. (B) Needle biopsy of the tumor shown in A.