O-arm CT for Confirmation of Successful Navigation During Robotic Assisted Bronchoscopy

Abstract

Background: Robotic assisted bronchoscopy (RAB) is designed to increase bronchoscopic accessibility for difficult to reach pulmonary lesions. One limitation to success of RAB is computed tomography (CT) to body divergence. Real time imaging with cone beam CT is increasingly utilized for confirmation of correct navigation and tool-in-lesion during RAB. O-arm CT is a 3-dimensional imaging modality, which has not previously been described for use with RAB. Our purpose is to display the feasibility, ease of use, and high rate of confirmation of tool-in-lesion when using O-arm CT during RAB.Methods: Single center, retrospective review of 75 patients undergoing RAB with intraprocedural use of O-arm CT.Results: Median patient age was 65 years. Forty-nine percent of cases involved nodules ≤ 2 cm. Bronchus sign was absent in 44% of cases. Median procedure time was 80 minutes. Median number of O-arm CT runs per case was 2. The median effective dose of radiation was 7.2 millisieverts. Tool-in-lesion was confirmed in 97% (77 of 79) of cases. Definitive diagnosis was reached in 61 to 68 of 79 cases (77% to 86%). There were 2 cases of pneumothorax (2.5%), one of which needed intervention with tube thoracostomy.Conclusions: O-arm CT is an effective, and convenient alternative to other 3-dimensional imaging modalities for intraprocedural confirmation of tool-in-lesion during RAB.

Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

“…A total of 26 studies were selected to review the full article. Of these, 16 studies were excluded: five studies did not report diagnostic results, 15 , 16 , 17 , 18 , 19 nine studies did not provide sufficient data to calculate the diagnostic yield according to our definition, 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 and two studies were excluded to avoid duplication of population. 29 , 30 Finally, 10 eligible studies with 725 lesions were included.…”

Robotic-Assisted Bronchoscopy Integrated with Three-Dimensional Fluoroscopy for Sampling Bilateral Pulmonary Nodules in a Single Procedure

“…Multiplanar 3D fluoroscopy during RAB was introduced to overcome this divergence, by providing imaging of the biopsy tool and allowing fine repositioning of the robotic tip toward the lesion within a safe range of radiation exposure [3,8]. The use of either shape-sensing or electromagnetic navigation RAB, with concurrent intraoperative imaging and rEBUS, has shown a diagnostic sensitivity of 77-91.7% [3,[9][10][11]. Although the combination of these two technologies requires an initial capital investment, the total cost of ssRABspecific supplies does not exceed $2,000 USD per procedure.…”

Observation of peripheral airways using ultra‐thin fiberscope

“…3 Technological adjuncts have only further improved the diagnostic performance of bronchoscopy for pulmonary nodules. 4,5 However, taking these techniques together, the diagnostic yield is around 70% at most. 6 This is because biopsy is often performed without direct visualization of the tumours.…”

“…Tomonari Kinoshita 1 Hideki Terai 2 Shinnosuke Ikemura 3 Nao Takada 4 Takahiro Fukui 4 Hidehiro Irie 4 Raita Miyazawa 5 Yohei Funatsu 4 Teppei Okamura 5 Hidefumi Koh 4 Tatsuya Yamamoto 1 Risa Shigematsu 2 Keiko Ohgino 2 Kiyoshi Oka 6 1 Division of General Thoracic Surgery, Department of Surgery, Tachikawa Hospital, Tokyo, Japan…”