S6 Robotic assisted bronchoscopy implementation within a UK tertiary referral centre

Introduction

Robotic-assisted bronchoscopy (RAB) is a new technology that allows respiratory physicians to sample peripheral nodules with increased accuracy compared to conventional bronchoscopy. RAB is an option for patients who are unable to have CT-guided biopsy or those individuals that require mediastinal staging and nodule biopsy in the same procedure. With the implementation of lung cancer screening, the demand for work up of pulmonary nodules is expected to increase.

Methods

This is a single centre retrospective analysis of a prospectively maintained database, consisting of consecutive cases following implementation of RAB within a tertiary peripheral bronchoscopy service. Patients underwent shape-sensing robotic-assisted bronchoscopy with the ION® endoluminal system (Intuitive Surgical) under general anaesthesia. Tissue acquisition was performed under fluoroscopy guidance. Patient characteristics (age, gender, smoking status, and previous history of cancer), nodule characteristics (density, size, location, Brock/Herder score, and SUV avidity) and procedure characteristics (duration, sampling and imaging techniques, adverse events, and diagnostic yield) were collected. Data are presented as frequency N(%), mean±standard deviation and median (interquartile range). Yield was defined according to a recent consensus statement and was considered positive if it allowed definitive patient management.

Results

63 robotic-assisted bronchoscopies were carried out between 23.1.24 and 20.6.24. 41(65%) patients referred for RAB were deemed unsuitable for CT guided biopsy, and 12(19%) had indeterminate mediastinal nodes that needed EBUS-staging as well as sampling of the lung nodule. 46% of patients were male with median age of 70 years (61–78). 76% of patients were current or former smokers. Solid lesions (N=53) were 29±15mm and subsolid lesions (N=11) were 32±12mm with 17±7mm solid component. 31% of lesions did not have an air bronchus sign on CT and 43% of lesions had only eccentric radial EBUS view initially. Diagnostic yield was 88%. Adverse events included pneumothorax requiring chest drain (3%) and bleeding requiring admission (1.6%). Procedural time decreased with increase in experience, figure 1.

Conclusion

Robotic-assisted bronchoscopy can be successfully implemented into a tertiary peripheral bronchoscopy programme with excellent diagnostic results. It is safe and well tolerated. Crucially, the technology provides a diagnostic option for individuals who cannot undergo a CT-guided biopsy.