Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodules Diagnosis During a Single Anesthetic Event

• Published in: Respiration
• Main Authors: Fernandez-Bussy, Sebastian, Garza-Salas, Ana, Barrios-Ruiz, Alanna, Balasubramanian, Prasanth, Yu Lee-Mateus, Alejandra, Koirala, Tapendra, Hazelett, Britney N, Chadha, Ryan, Patel, Neal M, Reisenauer, Janani S, Abia-Trujillo, David
• Format: Journal Article
• Language: English
• Published: Switzerland 22.04.2024

The widespread use of Computed tomography (CT) as a screening tool for early lung cancer has increased detection of pulmonary lesions. It is common to encounter patients with more than one peripheral pulmonary nodule (PPN) of uncertain etiology. Shape-sensing robotic-assisted bronchoscopy (ssRAB) emerges as a potential alternative to biopsy multiple PPN, in addition to mediastinal staging in single anesthetic procedure. Retrospective review of 22 patients who underwent ssRAB for evaluation of two or more PPN, between November 2021 and April 2023 at Mayo Clinic Florida, US. A total of 46 PPN were biopsied in 22 patients. All lesions were ≤ 2 cm with a maximum and minimum median lesion size of 1.40cm and 1.05cm, respectively. Diagnostic yield was 84.8% (n=39) and target reach was 91.3% (n=42). Most lesions were in the upper lobes, a solid pattern was found in 78.3% (n=36), bronchus sign was present in 82.6% of cases (n=38), 54.4% (n=25) were malignant nodules, and 30.4% (n=14) were benign. Fourteen patients had one malignant lesion out of two or more nodules sampled and ten patients had a malignant diagnosis for all sampled lesions. The complication rate was 9% (n=2) and pneumothorax rate was 4.5% (n=1). This study is, to our knowledge, the first to assess the use and safety of ssRAB for diagnosis of multiple PPN in a single anesthetic event. This procedure will mainly impact management decisions and subsequently shorten the time from diagnosis to treatment.