Robotic navigational bronchoscopy in a thoracic surgery practice: Leveraging technology in the management of pulmonary nodules

Andrew R Brownlee; Justin J J Watson; Akbarshakh Akhmerov; Shruthi Nammalwar; Qiudong Chen; Sevannah G Soukiasian; Harmik J Soukiasian

doi:10.1016/j.xjon.2023.07.004

Robotic navigational bronchoscopy in a thoracic surgery practice: Leveraging technology in the management of pulmonary nodules

JTCVS Open. 2023 Jul 17:16:1-6. doi: 10.1016/j.xjon.2023.07.004. eCollection 2023 Dec.

Authors

Andrew R Brownlee¹, Justin J J Watson¹, Akbarshakh Akhmerov¹, Shruthi Nammalwar¹, Qiudong Chen¹, Sevannah G Soukiasian¹, Harmik J Soukiasian¹

Affiliation

¹ Division of Thoracic Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, Calif.

Abstract

Objectives: Robotic navigational bronchoscopy is increasingly used to improve diagnostic yield for pulmonary nodules compared with the 50% to 60% obtained by standard bronchoscopy; however, safety and efficacy data are limited to small series. The aim of this study was to evaluate diagnostic yield and clinical outcomes in a large multisurgeon single-center cohort.

Methods: All patients who underwent robotic navigational bronchoscopy and biopsy from September 2020 to October 2022 were identified from a prospective institutional registry. The primary outcome was diagnostic yield. The secondary outcome was diagnostic yield for molecular testing.

Results: A total of 503 nodules were biopsied during the study period. Median nodule size was 2.1 cm. Overall diagnostic yield was 87.9%. Factors associated with increased diagnostic yield were decreased time from date of planning computed tomography to procedure date (odds ratio, 0.98; 95% CI, 0.96-0.99; P = .04) and greater nodule size (odds ratio, 1.03; 95% CI, 1.01-1.07; P = .02) per 0.1-cm increment. Molecular analysis was sent in 101 patients and was sufficient in 90% of cases. Complications occurred in 22 (5%) patients, including 13 (3.1%) with pneumothoraxes (7 patients requiring a chest drain), and 5 (1.2%) patients had bleeding requiring intraprocedural bronchial intervention. A total of 41 patients were consented for biopsy and resection during a single anesthetic event. Four of these cases were stopped at robotic navigational bronchoscopy due to an alternative diagnosis. Mean length of stay was 3.4 ± 1.1 days. There were no major complications.

Conclusions: This study suggests robotic navigational bronchoscopy has a high diagnostic yield and obtains adequate tissue for molecular analysis critical for selection of targeted therapies. With careful patient selection robotic navigational bronchoscopy can be combined with surgery to treat lung cancer as a single procedure with low complication rates.

Keywords: pulmonary nodules; robotic navigational bronchoscopy; robotic thoracic surgery.