Robotic Bronchoscopy for the Diagnosis of Peripheral Lung Nodules: a Review

Abstract

Purpose of Review Conventional bronchoscopy has limitations based on an inability to accurately reach and reliably diagnose peripheral lesions with many studies having a yield of less than 50%. Although newer technology such as virtual bronchoscopy, use of smaller bronchoscopes, peripheral endobronchial ultrasound, and electromagnetic navigation may have some improvements and a better safety profile, oftentimes transthoracic or surgical biopsies are required to establish a diagnosis and rule out malignancy. The purpose of this review is to highlight the potential benefits of robotic bronchoscopy, the latest in technological advances for this very common medical issue. Recent Findings Recently published early studies suggest the yield of robotic bronchoscopy may surpass 90%. Studies performed in cadavers and humans suggest robotic bronchoscopic platforms are better than currently existing bronchoscopic modalities for lung nodule diagnosis and have a favorable safety profile. Summary Although additional multi-center randomized clinical trials are needed, robotic bronchoscopy appears poised to supplement current bronchoscopic techniques for establishing a diagnosis of pulmonary nodules.

Autonomous medical needle steering in vivo

“…We also noticed that the physician-guided needle insertions were on average of greater length than existing clinical practice, likely reflecting the high risk tolerance of the physician in a nonclinical setting. Because manual needle insertion is not explicitly planned with respect to obstacles in the environment in current clinical practice, most clinical diagnostic bronchoscopy tools are limited to 20 to 30 mm of insertion ( 34 , 35 ). Our system was able to access more peripheral targets via autonomous needle steering by explicitly computing an obstacle-free trajectory in the parenchyma and following it under closed-loop robotic control.…”