Navigational bronchoscopy: a guide through history, current use, and developing technology

Abstract

The peripheral pulmonary nodule offers unique challenges to the clinician, especially in regards to diagnostic approach. Quite often the etiology of the nodule is spurious, though the specter of malignancy drives accurate classification of the nodule. Diagnostic approaches range in degrees of invasiveness, accuracy, and morbidity. Bronchoscopic access to these nodules had been plagued by low reported yields, especially in fluoroscopically invisible nodules. Navigational bronchoscopy, however, allowed more accurate access to peripheral nodules while maintaining a low morbidity, and thus reshaped the historic diagnostic algorithms.Though navigational bronchoscopy was initially associated with electromagnetic navigation, newer approaches to navigation and new technologies provide enthusiasm that yield can improve. In this article we will provide a historical approach to navigational bronchoscopy, from its origins to its current state, and we will discuss developing technology and its potential role in the evolving paradigm of the peripheral nodule biopsy.

Navigational Bronchoscopy with Interventional Pulmonologists and Thoracic Surgeons

“…Although navigation with direct visualization can be accomplished with the SPiN system, the robot-assisted platforms also allow for direct visualization of more distal airway segments due to the use of a smaller bronchoscope with an outer diameter of less than 4 mm. 11,21 The Monarch™ system has a novel bronchoscope and sheath telescoping design that provides an articulation range of 130 degrees and creates a more stable support to advance the bronchoscope within it. Once beyond the sheath, the bronchoscope has a 180 degrees mobility range that allows the operator to navigate the tortuous and more distal airway.…”

“…In Table 1, we briefly show the differences in diagnostic yield and pneumothorax rate of these systems, as previously described by Cicenia et al and Agrawal et al in their thorough reviews about this topic. 11,21 Conclusions A prompt and accurate diagnosis of small, peripheral lung lesions is essential to improve patient outcomes. Multiple minimally invasive techniques are now available to obtain an accurate diagnosis and at the same time reduce patient inconveniences and minimize adverse events.…”

“…3). 11,12 With this platform, thin slice, inspiration/expiration protocolized chest CT is performed on the same day immediately prior to the procedure and the images are uploaded into the SPiN computer. Then, the planning software takes the CT images and creates a 3D map of the lungs and airways.…”

“…12,13 The rate of pneumothorax with the SPiN Perc™ system has been reported between 17% and 21%, which is higher than the navigational bronchoscopy approach, however, it is similar to reported rates of pneumothorax with CT-guided TTNA. 11 -13 A multicenter prospective trial to determine the diagnostic yield with the use of the ENB component and/or the electromagnetic system with TTNA has been conducted with final results yet to be published. 14…”

The Future of Endoscopic Navigation: A Review of Advanced Endoscopic Vision Technology

“…[4]. The superDimension™ system and the Veran™ system are two primary electromagnetic (EM) navigational bronchoscopy platforms [5]. EDDA Technology has developed a puncture surgery navigation system (IQQA ® -BodyImaging; EDDA Tech., Princeton Junction, NJ, USA) to support various types of MISs for chest and abdomen tumours.…”