Robotic Bronchoscopy for Peripheral Pulmonary Lesions: A Multicenter Pilot and Feasibility Study (BENEFIT)

Alexander C Chen, Nicholas J Pastis Jr, Amit K Mahajan, Sandeep J Khandhar, Michael J Simoff, Michael S Machuzak, Joseph Cicenia, Thomas R Gildea, Gerard A Silvestri, Alexander C Chen, Nicholas J Pastis Jr, Amit K Mahajan, Sandeep J Khandhar, Michael J Simoff, Michael S Machuzak, Joseph Cicenia, Thomas R Gildea, Gerard A Silvestri

Abstract

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.

Clinical trial registration: ClinicalTrials.gov; No.: NCT03727425; URL: www.clinicaltrials.gov.

Keywords: peripheral pulmonary lesion; radial probe endobronchial ultrasound imaging; rapid on-site evaluation; robotic bronchoscopy.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Robotic bronchoscopy components: Robotic tower and handheld controller.
Figure 2
Figure 2
Robotic system user interface shows live bronchoscopic, electromagnetic navigation bronchoscopy with targeting, and multiplanar CT views.
Figure 3
Figure 3
A-C: A, CT image; B, concentric radial endobronchial ultrasound view; C, robotic bronchoscopy with transbronchial needle aspiration.

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