Multiplanar 3D fluoroscopy redefines tool–lesion relationship during robotic‐assisted bronchoscopy

Abstract

Guided bronchoscopy platforms have rapidly evolved over the past two decades to allow high-yield tissue acquisition of suspicious peripheral pulmonary nodules. 1 Robotic-assisted bronchoscopy platforms aim to overcome limitations of conventional guided bronchoscopy by allowing for precision access to smaller and more peripheral lesions. 2 The Ion Robotic-Assisted Endoluminal Platform (Intuitive Surgical, Sunnyvale, CA, USA) features a console-controlled catheter with an outer diameter of 3.5 mm and a 2.0-mm working channel. Localization within the airway tree is based on a shape-sensing fibre embedded along the catheter's length and navigation is based on a computed tomography (CT)-generated virtual road map. 2 Following navigation, adjunctive imaging techniques are used to confirm approximation to the lesion. Conventional modalities include radial probe endobronchial ultrasound (RP-EBUS) and 2D fluoroscopy. Cios-Spin (Siemens Healthineers, Forchheim, Germany) is a mobile 2D-3D C-arm that produces intraoperative 1952 × 1952 pixel images over an area of 295 × 295 mm 2. 3 Multiplanar 3D imaging is obtained

Combining Shape-Sensing Robotic Bronchoscopy With Mobile Three-Dimensional Imaging to Verify Tool-in-Lesion and Overcome Divergence: A Pilot Study

“…The relationship between the biopsy tool and lesion was improved in 3 instances (30% of the time) after the subsequent redeployment of the tool, which was based on direct feedback from the intraoperative portable CT imaging. 14 The result of our study is in agreement with these results, with an overall tool-in-lesion rate of 97%, with an average of only 1 manipulation per nodule.…”

“…Tool-in-lesion was obtained in 100% of procedures, but this did not correlate with diagnostic yield. Kalchiem-Dekel et al 14 also recently reported their experience with 10 lesions in 5 patients using the Intuitive Ion platform in conjunction with the CIOS Mobile 3D spin. They identified tool-in-lesion in 90% of their patients.…”

“… 11 With the emergence of robotic bronchoscopy, proceduralists can now navigate farther in the airways to lesions completely extrinsic to the airways, with biopsy yields reported from 69.1%-81.7%. 12 , 13 , 14 , 15…”

Advances in Diagnostic Bronchoscopy

“…A small, retrospective, single-center study of 10 patients reported 90% diagnostic yield using RP-EBUS, robotic-assisted navigation with the Ion platform, and multiplanar 3D fluoroscopy with a Cios-Spin mobile 3D C-arm. Navigation to the target was successful in all cases [133].…”

Improving diagnostic yield of navigational bronchoscopy for peripheral pulmonary lesions: a review of advancing technology

“…Notably, 3 of 10 tool-lesion relationships were improved with the 3D fluoroscopy imaging. Diagnostic yield was found to be 90% independent of the lesion's size, location, or r-EBUS image (28).…”