Robotic bronchoscopy for pulmonary lesions: a review of existing technologies and clinical data

Abstract

Bronchoscopic interventions are preferred for sampling suspicious pulmonary lesions as they have lower complications and can achieve diagnosis and staging in one single procedure. Limitations in existing guided bronchoscopy platforms has led to developments in robotic assisted technologies. These devices may allow the bronchoscopist to more precisely maneuver the scope and instruments into the periphery of the lungs under direct visualization while also ensuring stability during sampling of the target lesions. These devices have the potential to improve the diagnostic yield in sampling peripheral lung lesions and may play a role in the treatment of non-operable or oligometastatic peripheral tumors using bronchoscopic ablative therapies. In this article, we review the existing robotic bronchoscopy technologies and summarize the available pre-clinical and clinical data supporting their use.

Keywords: Robotic bronchoscopy; biopsy; lung cancer; navigational bronchoscopy; peripheral lung lesion.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.03.35). The series “Novel Diagnostic Techniques for Lung Cancer” was commissioned by the editorial office without any funding or sponsorship. AA has no financial disclosures or conflicts of interest. DKH reports personal fees and other from Auris, personal fees from Ambu, personal fees, non-financial support and other from Body Vision, personal fees and other from Eolo, other from Eon, other from Gravitas, personal fees and other from Noah Medical, personal fees and other from LX-Medical, other from Med-Opsys, other from Monogram Orthopedics, personal fees and other from Preora, other from VIDA, other from Viomics, personal fees from Boston Scientific, personal fees from Johnson and Johnson, personal fees from oncocyte, personal fees from veracyte, personal fees and other from Broncus, grants and personal fees from Gala, personal fees from Heritage Biologics, IDbyDNA, Level-Ex, Medtronic, Neurotronic, Olympus, PulmonX, Astra-Zeneca, Biodesix, Genetech, Grifols, Takeda, CSL, and InhibRX, outside the submitted work; none of these COI have anything to do with this paper or my work on this paper. SM is an educational consultant for Olympus, Boston Scientific, Pinnacle Biologics, Cook Medical and Johnson and Johnson. He has received grants from Medtronic and Pinnacle Biologics. All of these disclosures are outside the submitted work.

2020 Journal of Thoracic Disease. All rights reserved.

Figures

Figure 1

MonarchTM platform by Auris Health. (A) Computed tomography (CT) image of the right upper lobe nodule; (B) real time white light bronchoscopy view and target view on the MonarchTM platform; (C) fluoroscopic image of robotic bronchoscope; (D) eccentric radial EBUS view of peripheral pulmonary nodule on the right side.

Figure 2

IonTM endoluminal system by intuitive surgical. (A) Computed tomography (CT) image of the right upper lobe nodule (arrow); (B) target view, concentric radial EBUS view and fluoroscopic image of the robotic bronchoscope.