Robotic Bronchoscopy for Diagnosis of Suspected Lung Cancer: A Feasibility Study

José R Rojas-Solano, Luis Ugalde-Gamboa, Michael Machuzak, José R Rojas-Solano, Luis Ugalde-Gamboa, Michael Machuzak

Abstract

Background: Robotic bronchoscopy may offer alternative approaches to address limitations of current bronchoscopic techniques for biopsy of suspected peripheral lung lesions. This study sought to evaluate complications and feasibility of robotic bronchoscopy performed with the Robotic Endoscopy System (RES).

Methods: Adult patients from a single institution underwent bronchoscopy of suspected lesions with a bronchus sign with the RES. The primary outcome was complication rate, as assessed by the incidence of related serious adverse events (SAE). The secondary outcome was technical feasibility. Data are presented as median (range), counts, and percentage. P-value was calculated using the Mann-Whitney U test.

Results: Of 17 screened patients, 15 were eligible. The median age was 67 (38 to 79) years. The lesions (12 peripheral and 3 central) were located in the right lower lobe (33%), right upper lobe (27%), left upper lobe (27%), and left lower lobe (13%). No SAE, including pneumothorax and significant bleeding, occurred. Biopsy samples were obtained from 93% of patients. One sampling (right upper lobe) required conventional bronchoscopy and another required surgery to confirm malignancy. Cancer was confirmed in 60% (9/15) of patients. Benign features were found in 5 of 6 patients. Time to biopsy location reduced from 45 (21 to 84) minutes (first 5 cases) to 20 (7 to 47) minutes (last 9 cases), P=0.039.

Conclusions: The study results and absence of SAE support feasibility of the RES in accessing the periphery of the lung. The RES has potential to address challenges associated with biopsy of peripheral lung lesions.

Figures

FIGURE 1
FIGURE 1
The Robotic Endoscopy System used in the study.
FIGURE 2
FIGURE 2
The robotic endoscope used in the study (A). A distal view of the bronchoscope (B). The bronchoscope includes a camera that provides endoscopic visualization to the operator during the procedure and integrated illumination fibers that transmit light from the proximal light source to the surgical field Robotic endoscope proximal handle (C).
FIGURE 3
FIGURE 3
Manual characterization of targeted lesions.
FIGURE 4
FIGURE 4
Direct visualization of a distal endobronchial lesion and a biopsy instrument during tissue acquisition.

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