Robotic bronchoscopy shows promise in patients with peripheral pulmonary lesions

Results from a prospective, multicenter study demonstrate feasibility and safety of robotic bronchoscopy in patients with peripheral pulmonary lesions, researchers reported in Chest.

“The American College of Chest Physicians clinical practice guidelines currently recommend guided bronchoscopy for the diagnosis of peripheral pulmonary lesions when lung cancer is suspected,” Alexander C. Chen, MD, associate professor of medicine in the division of pulmonary and critical care medicine, associate professor of surgery in the division of cardiothoracic surgery and director of interventional pulmonology at Washington University School of Medicine, St. Louis, and colleagues wrote. “Despite experience with a myriad of bronchoscopic approaches over the past 10 years, the diagnosis of peripheral nodules continues to present a significant challenge to clinicians.”

The prospective, multicenter pilot and feasibility study included 54 patients (mean age, 67.1 years; 53.7% women) with peripheral pulmonary lesions 1 cm to 5 cm in size at five centers. The robotic bronchoscopic system (Monarch, Auris Health) features a tower, monitor and a unit that houses arms to control insertion, retraction and articulation of an outer sheath and inner scope.

In this study, robotic bronchoscopy was performed in patients with direct visualization, electromagnetic navigation and fluoroscopy. After radial probe endobronchial ultrasound imaging, transbronchial needle aspiration was performed. In all cases, rapid on-site evaluation was used. Transbronchial needle aspiration was deemed sufficient when rapid on-site evaluation was diagnostic; when rapid on-site evaluation was not diagnostic, transbronchial biopsy was performed using robotic bronchoscopy and then conventional guided bronchoscopic approaches at the investigator’s discretion, according to the study.

The primary endpoints were successful lesion localization using radial probe endobronchial ultrasound imaging and the incidence of procedure-related adverse events.

Radial probe endobronchial ultrasound images were available for 53 patients. The median lesion size was 23 mm (42.6%, 10-20 mm; 35.2%, 21-30 mm; 22.2%, 31-50 mm).

Robotic bronchoscopy resulted in successful lesion localization in 96.2% (95% CI, 86.5-99.7) of patients. Median time to lesion confirmation was 13 minutes. Median procedure time from robotic scope insertion to removal was 51 minutes.

Pneumothorax occurred in two patients (3.7%). One patient (1.9%) required tube thoracostomy. The researchers reported no additional significant adverse events and no evidence of airway trauma after robotic bronchoscope use.

According to the researchers, this is the first prospective, multicenter trial of robotic bronchoscopy in patients with peripheral pulmonary lesions.

The results “demonstrate the feasibility and safety of performing robotic bronchoscopy in patients with peripheral pulmonary lesions with the use of a prospectively designed, multicenter approach, with strict definitions of diagnostic and nondiagnostic biopsy specimens,” the researchers wrote. “We believe that demonstrating safety and the ability to locate peripheral lesions is an integral first step in the evolution of this technology.”

The researchers said there is a need for additional studies to address variability in diagnostic yield in larger, prospective, comparative-effectiveness trials with clearly defined endpoints.