Lung Nodule Management

An Interventional Pulmonology Perspective

Udit Chaddha, MBBS; Jonathan S. Kurman, MD, MBA; Amit Mahajan, MD, FCCP; D. Kyle Hogarth, MD


Semin Respir Crit Care Med. 2018;39(6):661-666. 

In This Article

Robotic Bronchoscopy

When biopsy instruments are advanced into the peripheral bronchial tree to biopsy a small nodule, the operator can neither directly see them nor steer them. Robotic bronchoscopy is a platform that provides direct visualization of peripheral airways while also allowing visualization of biopsy tools. A robotic bronchoscope consists of robotic arms that contain rotatory pulleys that drive the bronchoscope. The physician uses a controller to drive the bronchoscope that is composed of an outer sheath and an inner scope that possesses four-way steering control and a distal section capable of achieving articulation in pitch and/or yaw, thereby achieving precise control. The scope can be locked in position and the instruments advanced through the working channel without exertion of torque onto the bronchoscope, minimizing airway distortion. This, along with the better column strength and telescoping design, enables superior peripheral reach, despite the diameter of the robotic scopes being no smaller than contemporary thin bronchoscopes. The system uses an electromagnetic field generator and reference sensors much like other EMN bronchoscopy systems.

A pilot study by Fielding et al on the Intuitive Surgical, Inc. robotic platform showed a diagnostic yield of 83% in 30 cases, in which the mean maximal diameter of the nodule was 15.3 mm.[51] Rojas-Solano et al recently published a feasibility study on 15 patients using the Robotic Endoscopy System (Auris Surgical Robotics, San Carlos, CA).[52] While these promising technologies have the potential to overcome some of the limitations of conventional and EMN bronchoscopy, they still need to be prospectively studied before further conclusions can be drawn.