Robot-assisted bronchoscopy for pulmonary lesion diagnosis: results from the initial multicenter experience

Chaddha, Udit; Kovacs, Stephen P.; Manley, Christopher; Hogarth, D. Kyle; Cumbo-Nacheli, Gustavo; Bhavani, Sivasubramanium V.; Kumar, Rohit; Shende, Manisha; Εgan, John; Murgu, Septimiu

doi:10.1186/s12890-019-1010-8

Cited by 122 publications

(99 citation statements)

References 18 publications

(24 reference statements)

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“…The authors acknowledged that atelectasis resulting in false-positive rEBUS images and lack of long-term follow-up may impact the interpretation of the results, and that true confirmation of navigation success requires CBCT or tool-in-target visualization. 35 CBCT has demonstrated very high diagnostic accuracy when used alone or in combination with other systems; however, access to these systems is currently limited. 13 In an abstract report evaluating the localization accuracy of the LungVision system on the basis of CBCT confirmation, successful navigation was verified by CBCT in 91% of cases despite an initial CT-to-body divergence of 14 mm.…”

Section: Discussionmentioning

confidence: 99%

Electromagnetic Navigation Bronchoscopy With Tomosynthesis-based Visualization and Positional Correction

Pritchett

Bhadra

Mattingley

2020

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Electromagnetic navigation bronchoscopy (ENB) aids in lung lesion biopsy. However, anatomic divergence between the preprocedural computed tomography (CT) and the actual bronchial anatomy during the procedure can limit localization accuracy. An advanced ENB system has been designed to mitigate CT-to-body divergence using a tomosynthesis-based software algorithm that enhances nodule visibility and allows for intraprocedural local registration. Materials and Methods: A prospective, 2-center study was conducted in subjects with single peripheral lung lesions ≥10 mm to assess localization accuracy of the superDimension navigation system with fluoroscopic navigation technology. Three-dimensional accuracy was confirmed by cone-beam computed tomography. Complications were assessed through 7 days. Results: Fifty subjects were enrolled (25 per site). Lesions were <20 mm in 61.2% (30/49). A bronchus sign was present in 53.1% (26/49). Local registration was completed in 95.9% (47/49). Three-dimensional target overlap (primary endpoint) was achieved in 59.6% (28/47) and 83.0% (39/47) before and after location correction, respectively. Excluding subjects with unevaluable video files, target overlap was achieved 68.3% (28/41) and 95.1% (39/41), respectively. Malignant results were obtained in 53.1% (26/49) by rapid on-site evaluation and 61.2% (30/49) by final pathology of the ENB-aided sample. Diagnostic yield was not evaluated. Procedure-related complications were pneumothorax in 1 subject (no chest tube required) and scant hemoptysis in 3 subjects (no interventions required). Conclusion: ENB with tomosynthesis-based fluoroscopic navigation improved the 3-dimensional convergence between the virtual target and actual lung lesion as confirmed by cone-beam computed tomography. Future studies are necessary to understand the impact of this technology on diagnostic yield.

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Section: Discussionmentioning

confidence: 99%

Electromagnetic Navigation Bronchoscopy With Tomosynthesis-based Visualization and Positional Correction

Pritchett

Bhadra

Mattingley

2020

Journal of Bronchology &Amp; Interventional Pulmonology

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“… 7 , 8 Presently, very few data exist regarding the use of a robotic endoscopic system in live human subjects with peripheral lesions in need of biopsy. 9 , 10 …”

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confidence: 99%

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Chen

Pastis

Mahajan

et al. 2021

Chest

142

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BACKGROUND: The diagnosis of peripheral pulmonary lesions (PPL) continues to present clinical challenges. Despite extensive experience with guided bronchoscopy, the diagnostic yield has not improved significantly. Robotic-assisted bronchoscopic platforms have been developed potentially to improve the diagnostic yield for PPL. Presently, limited data exist that evaluate the performance of robotic systems in live human subjects. RESEARCH QUESTION: What is the safety and feasibility of robotic-assisted bronchoscopy in patients with PPLs? STUDY DESIGN AND METHODS: This was a prospective, multicenter pilot and feasibility study that used a robotic bronchoscopic system with a mother-daughter configuration in patients with PPL 1 to 5 cm in size. The primary end points were successful lesion localization with the use of radial probe endobronchial ultrasound (R-EBUS) imaging and incidence of procedure related adverse events. Robotic bronchoscopy was performed in patients with the use of direct visualization, electromagnetic navigation, and fluoroscopy. After the use of R-EBUS imaging, transbronchial needle aspiration was performed. Rapid on-site evaluation (ROSE) was used on all cases. Transbronchial needle aspiration alone was sufficient when ROSE was diagnostic; when ROSE was not diagnostic, transbronchial biopsy was performed with the use of the robotic platform, followed by conventional guided bronchoscopic approaches at the discretion of the investigator. RESULTS: Fifty-five patients were enrolled at five centers. One patient withdrew consent, which left 54 patients for data analysis. Median lesion size was 23 mm (interquartile range, 15 to 29 mm). R-EBUS images were available in 53 of 54 cases. Lesion localization was successful in 51 of 53 patients (96.2%). Pneumothorax was reported in two of 54 of the cases (3.7%); tube thoracostomy was required in one of the cases (1.9 %). No additional adverse events occurred. INTERPRETATION: This is the first, prospective, multicenter study of robotic bronchoscopy in patients with PPLs. Successful lesion localization was achieved in 96.2% of cases, with an adverse event rate comparable with conventional bronchoscopic procedures. Additional large prospective studies are warranted to evaluate procedure characteristics, such as diagnostic yield.

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“…RB is a novel platform to biopsy pulmonary nodules, particularly in comparison with ENB ( 2 – 4 ). In a prospective, randomized, single-blinded trial in a cadaveric model, data showed operators using RB had an improved ability to navigate to and accurately biopsy peripheral pulmonary nodules ( 5 ).…”

mentioning

confidence: 99%

Cognitive Load in Electromagnetic Navigational and Robotic Bronchoscopy for Pulmonary Nodules

Kapp

Akulian

et al. 2021

ATS Scholar

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Background: Electromagnetic navigational bronchoscopy (ENB) and robotic-assisted bronchoscopy (RB) require a high degree of decision-making and psychomotor skill. Cognitive load theory is the overall effort expended by individuals in response to a task and is closely related to the usability of devices for medical procedures. High cognitive workload leads to poor surgical outcomes and represents a bottleneck for learning that affects performance. Objective: To analyze the cognitive load associated with ENB and RB in experienced ENB practitioners learning RB. Methods: Six experienced ENB bronchoscopists performed ENB and RB on a human cadaver model of peripheral pulmonary nodules. To assess cognitive load, we used the Surgery Task Load Index (SURG-TLX) and biometric changes. The SURG-TLX questionnaire was given to the provider after every peripheral pulmonary nodule biopsy with ENB and RB. Pupillary dilation and screen changes were continuously measured throughout the procedure for each biopsy attempt to collect biometric measures of cognitive load. Procedural time and biopsy outcome were also recorded. Results: Forty procedures (ENB and RB) were analyzed. Task complexity (23%) and mental demand (21.4%) were the highest contributors to cognitive load in ENB and RB. The cumulative SURG-TLX was significantly lower for the RB (69.25 vs. 101.25; P < 0.01). Total procedure time was greater for ENB (6.7 min; SD 1.5) compared with RB (4.4 min; SD 1.5; P = 0.01). Pupillary diameter was similar across the modalities (RB vs. ENB), but the diameter was higher during the biopsy portion (4.25 mm) than the navigation portion (4.01 mm). Conclusion: The intrinsic cognitive load of RB was highly manageable by existing ENB practitioners, and in this study, RB appeared to be less mentally demanding. Future development and training should focus on task complexity and mental demand for RB. The biopsy portion, regardless of bronchoscopic modality, should be a focus for education and training.

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Robot-assisted bronchoscopy for pulmonary lesion diagnosis: results from the initial multicenter experience

Cited by 122 publications

References 18 publications

Electromagnetic Navigation Bronchoscopy With Tomosynthesis-based Visualization and Positional Correction

Electromagnetic Navigation Bronchoscopy With Tomosynthesis-based Visualization and Positional Correction

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Cognitive Load in Electromagnetic Navigational and Robotic Bronchoscopy for Pulmonary Nodules

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