The Evolutional History of Electromagnetic Navigation Bronchoscopy

Mehta, Atul C.; Hood, Kristin L.; Schwarz, Yehuda; Solomon, Stephen B.

doi:10.1016/j.chest.2018.04.029

Cited by 79 publications

(55 citation statements)

References 103 publications

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“…Procedure-related complications are comparable to those from other guided bronchoscopy studies, with a 3.6% pneumothorax and 2.4% bleeding rate(2,4,12). While bleeding during RAB can bemanaged with injection of cold saline through the working channel of the robotic scope, in cases of suspected significant bleed, we have decided to disconnect the robotic scope and introduce a therapeutic flexible bronchoscope (2.8 mm working channel) to evaluate and potentially control the hemorrhage.…”

supporting

confidence: 53%

Robot-Assisted Bronchoscopy for Pulmonary Lesion Diagnosis: Results from the Initial Multicenter Experience

Chaddha

Kovacs

Manley

et al. 2019

Preprint

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Background: The Robotic Endoscopic System (Auris Health, Inc., Redwood City, CA) has the potential to overcome several limitations of contemporary guided-bronchoscopic technologies for the diagnosis of lung lesions. Our objective is to report on the initial post-marketing feasibility, safety and diagnostic yield of this technology. Methods: We retrospectively reviewed data on consecutive cases in which robot-assisted bronchoscopy was used to sample lung lesions at four centers in the US (academic and community) from June 15th, 2018 to December 15th, 2018. Results: One hundred and sixty-seven lesions in 165 patients were included in the analysis, with an average follow-up of 185 ± 55 days. The average size of target lesions was 25.0 ± 15.0 mm. Seventy-one percent were located in the peripheral third of the lung. Pneumothorax and airway bleeding occurred in 3.6% and 2.4% cases, respectively. Navigation was successful in 88.6% of cases. Tissue samples were successfully obtained in 98.8%. The diagnostic yield estimates ranged from 69.1% to 77% assuming the cases of biopsy-proven inflammation without any follow-up information (N=13) were non-diagnostic and diagnostic, respectively. The yield was 81.5%, 71.7% and 26.9% for concentric, eccentric and absent r-EBUS views, respectively. Diagnostic yield was not affected by lesion size, density, lobar location or centrality. Conclusions: RAB implementation in community and academic centers is safe and feasible, with an initial diagnostic yield of 69.1-77% in patients with lung lesions that require diagnostic bronchoscopy. Comparative trials with the existing bronchoscopic technologies are needed to determine cost-effectiveness of this technology.

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supporting

confidence: 53%

Robot-Assisted Bronchoscopy for Pulmonary Lesion Diagnosis: Results from the Initial Multicenter Experience

Chaddha

Kovacs

Manley

et al. 2019

Preprint

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“…have been widely used to diagnose peripheral lung lesions under the guidance of artificial intelligence [17][18][19]. Therefore, bronchoscopy for peripheral lung lesions that depends solely on the interpretation of a CT scan by a doctor may be regarded as an outdated method.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of ultra-low dose CT for bronchoscopy of peripheral lung lesions

Eom

Lee

Kim

et al. 2020

Preprint

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Background Thin-section CT is essential for identification of small bronchi during bronchoscopy using radial endobronchial ultrasound. Some patients should receive an additional CT for a thin-section image. We performed a retrospective study with a prospectively collected database to identify the optimal radiation dose for thin-section CT during peripheral bronchoscopy.Methods In total, 91 patients with peripheral lung lesions underwent thin-section CT (both standard CT as a reference and ultra-low dose CT [LDCT]). The patients were randomly assigned to one of four groups according to the ultra-LDCT parameters: group 1 = 120 kVp, 25 mAs; group 2 = 100 kVp, 15 mAs; group 3 = 120 kVp, 5 mAs; and group 4 = 100 kVp, 5 mAs. Two radiologists and two physicians analyzed both the standard CT and ultra-LDCT. ResultsThe effective doses (EDs) of ultra-LDCT significantly differed among the four groups (median EDs were 0.88, 0.34, 0.19, and 0.12 mSv for groups 1-4, respectively; P < 0.001). Median differences in peripheral airway wall thickness were higher in group 4 than in other groups (differences in median wall thickness measured by two radiologists were 0.4-0.5 mm and 0.8-0.9 mm for groups 1-3 and group 4, respectively). Bronchus signs on ultra-LDCT in groups 1 and 2 were well correlated with those of the standard dose CT (accuracies of two radiologists and two pulmonary physicians were 95-100%). ConclusionsOur results indicate that ultra-LDCT with ED of > 0.34 mSv (ED of group 2) is feasible for peripheral bronchoscopy.

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“…EBN has been recommended in the guidelines of the ACCP, with a 1C recommendation grade, in patients with PPLs difficult to reach with conventional bronchoscopy, if the equipement and expertise are available 2,45 and was also recently added to the interventional pulmonology fellowship accreditation standards. 46 • Theoretical lessons and practice on imaging of pulmonary nodules and the mediastinum;…”

Section: Ebn/vpnmentioning

confidence: 99%

Competence in navigation and guided transbronchial biopsy for peripheral pulmonary lesions

Livi

Barisione

Zuccatosta³

et al. 2019

Panminerva Med

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A B S T R A C TOptions for non-surgical tissue diagnosis of the peripheral nodule include CT scan-guided TTNA, fluoroscopy-guided bronchoscopy, radial endobronchial ultrasound (EBUS), electromagnetic navigation bronchoscopy (ENB), and virtual bronchoscopy navigation (VBN). For physicians who choose to pursue non-surgical biopsy, the decision to perform CT scan-guided or ultrasound-guided TTNA, conventional bronchoscopy or bronchoscopy guided by EBUS, ENB, or VBN will depend on a number of factors. CT scan-guided TTNA is preferable for nodules located near the chest wall or for deeper lesions, provided that there is no need to go through the fissures and there is no surrounding emphysema. Ultrasound-guided TTNA requires contact between the lesion and the costal pleura. Bronchoscopic techniques are preferable for nodules ≥2 cm located near a patent bronchus, or in individuals at high risk for pneumothorax following TTNA. In most other situations, operator experience should guide the decision. Trainees must possess a perfect knowledge of anatomy and be fully competent in the interpretation of imaging (CT with contrast medium and PET) and have a thorough knowledge of navigation technology in all its complexities. Practical training can be performed on animal, cadaver or plastic models. In the last years, to improve diagnostic yield, navigational bronchoscopy has attracted significant attention.

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The Evolutional History of Electromagnetic Navigation Bronchoscopy

Cited by 79 publications

References 103 publications

Robot-Assisted Bronchoscopy for Pulmonary Lesion Diagnosis: Results from the Initial Multicenter Experience

Robot-Assisted Bronchoscopy for Pulmonary Lesion Diagnosis: Results from the Initial Multicenter Experience

Feasibility of ultra-low dose CT for bronchoscopy of peripheral lung lesions

Competence in navigation and guided transbronchial biopsy for peripheral pulmonary lesions

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