Abstract Robotic‐assisted bronchoscopy (RAB) is a newly developed bronchoscopic technique for the diagnosis of peripheral pulmonary lesions (PPLs). The objective of this meta‐analysis was to analyze the diagnostic yield and safety of RAB in patients with PPLs. Five databases (PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov) were searched from inception to April 2023. Two independent investigators screened retrieved articles, extracted data, and assessed the study quality. The pooled diagnostic yield and complication rate were estimated. Subgroup analysis was used to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and the Egger test. Sensitivity analysis was also conducted to assess the robustness of the synthesized results. A total of 725 lesions from 10 studies were included in this meta‐analysis. No publication bias was found. Overall, RAB had a pooled diagnostic yield of 80.4% (95% CI: 75.7%–85.1%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield. Heterogeneity exploration showed that studies using cryoprobes reported better yields than those without cryoprobes (90.0%, 95% CI: 83.2%–94.7% vs. 79.0%, 95% CI: 75.8%–82.2%, p < 0.01). The pooled complication rate was 3.0% (95% CI: 1.6%–4.4%). In conclusion, RAB is an effective and safe technique for PPLs diagnosis. Further high‐quality prospective studies still need to be conducted.

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

Background: Computed tomography to body divergence (CTBD) is one of the main barriers to bronchoscopic techniques for the diagnosis of peripherally located lung nodules. Cone-beam CT (CBCT) guidance is being rapidly adopted to correct for this phenomenon and to potentially increase diagnostic outcomes. In this trial, we hypothesized that the addition of mobile CBCT (m-CBCT) could improve the rate of tool in lesion (TIL) and the diagnostic yield of shape-sensing robotic-assisted bronchoscopy (SS-RAB). Methods: This was a prospective, single-arm study, which enrolled patients with peripheral lung nodules of 1–3 cm and compared the rate of TIL and the diagnostic yield of SS-RAB alone and combined with mCBCT. Results: A total of 67 subjects were enrolled, the median nodule size was 1.7 cm (range, 0.9–3 cm). TIL was achieved in 23 patients (34.3%) with SS-RAB alone, and 66 patients (98.6%) with the addition of mCBCT (p &lt; 0.0001). The diagnostic yield of SS-RAB alone was 29.9% (95% CI, 29.3–42.3%) and it was 86.6% (95% CI, 76–93.7%) with the addition of mCBCT (p &lt; 0.0001). There were no pneumothoraxes or any bronchoscopy-related complications, and the median total dose–area product (DAP) was 50.5 Gy-cm2. Conclusions: The addition of mCBCT guidance to SS-RAB allows bronchoscopists to compensate for CTBD, leading to an increase in TIL and diagnostic yield, with acceptable radiation exposure. 

Improving Shape-Sensing Robotic-Assisted Bronchoscopy Outcomes with Mobile Cone-Beam Computed Tomography Guidance

Diagnostic performance of Shape-Sensing Robotic-Assisted bronchoscopy with mobile Cone-Beam CT for cystic and cavitary pulmonary lesions

The integration of medical robots is revolutionizing clinical medicine, especially in procedures requiring precision in instrument manipulation and navigation within the body using medical imaging techniques like fluoroscopy, CT, and MRI. This is particularly challenging in peripheral lung lesion examinations, where guiding long, flexible instruments through the lung airways to the target exposes medical professionals and patients to harmful X-ray radiation. Several robotic approaches exist but there are still shortcomings in terms of their large footprint in the operating room and complex and costly mechanical structure. The goal of our research was to develop and test the early feasibility of RoboCath, an innovative robotic platform designed for the adaptable navigation of long, flexible catheter-like medical instruments through the lung airways. RoboCath seamlessly integrates with existing medical devices, such as bronchoscopes, facilitating access to lower lung regions with precision. Its compact design is ideal for crowded operating rooms, ensures sterilization compatibility, and supports a broad range of procedures, including those requiring intricate instrument manipulation and medical imaging for navigation. This technology significantly reduces the reliance on X-ray, thereby minimizing radiation exposure to both healthcare providers and patients. The RoboCath system represents a significant advancement in the field of medical robotics, offering a novel solution to the challenges of lung lesion biopsy and diagnosis, with potential applications in various open orifice procedures.

Design and Technical Feasibility Testing of a Medical Robot for Flexible Catheter Navigation Inside the Lung Airways

Purpose of review Robotic Assisted bronchoscopy has emerged as an important tool in diagnosing small peripheral lung nodules in the era of CT screening. This paper reviews results from recent publications. Recent findings Three meta -analyses have now been reported. Diagnostic yields reported in studies must be considered in terms of the study prevalence of malignancy, which if high tends to give higher overall diagnostic yield. Diagnostic yields are consistently an improvement on earlier technologies, particularly for lesions &lt;20 mm in size. A range of imaging modalities have emerged as significant ways to improve diagnostic yield in Robotic procedures. These may be “stand alone” or integrated into the robotic systems. Robotic procedures may be performed under a single anaesthetic with planned surgical excision, the latter being guided by rapid on-site assessment or frozen section. Learning curve appears to be short and high levels of diagnostic performance with good safety profile have been reported. Summary Ongoing clinical study with robotic nodule biopsy will continue given the significant advance it has provided to clinicians in the first 5 years of its introduction. 

Robotic assisted bronchoscopy for peripheral pulmonary nodules – data review

Review question / Objective: What is the overall diagnostic yield and complication rate of robotic-assisted bronchoscopy for peripheral pulmonary lesions? Condition being studied: Many of peripheral pulmonary lesions (PPLs) may represent early-stage lung cancer. Lung cancer is the leading cause of cancer mortality globally. Early diagnosis and treatment of lung cancer are crucial for a better prognosis. With the widespread use of low-dose computed tomography (LDCT), the detection rate of PPLs is increasing. As a result, the number of PPLs requiring biopsy is progressively increasing. Transbronchial lung biopsy (TBLB) and transthoracic needle aspiration (TTNA) are the main modalities of non-surgical biopsy for PPLs. TTNA has a diagnostic yield of 90%, however, it also has a pneumothorax rate of 25%. Since TBLB avoids destroying the structure of normal pleura and lung tissue, the incidence of complications is lower. Unfortunately, traditional flexible bronchoscopy has a modest sensitivity of 34% and 63% for lesions 2 cm, respectively. The advent of guided bronchoscopy has increased the diagnostic yield to 70%. However, there is still a gap in diagnostic yield compared with TTNA. The advent of robotic-assisted bronchoscopy (RAB) is expected to further improve the diagnostic yield of TBLB for PPLs. However, the diagnostic performance of RAB for PPLs has not reached a consensus.

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

Weakly Supervised Hierarchical Multi-Label Classification of Lung Cancer Types Based on Rapid On-Site Evaluation in Transbronchial Biopsy

Late Breaking Abstract - Shape-sensing robotic-assisted bronchoscopy in transbronchial radiofrequency ablation for early-stage peripheral non-small cell lung cancer: an initial clinical experience

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

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

Weakly Supervised Hierarchical Multi-Label Classification of Lung Cancer Types Based on Rapid On-Site Evaluation in Transbronchial Biopsy

Late Breaking Abstract - Shape-sensing robotic-assisted bronchoscopy in transbronchial radiofrequency ablation for early-stage peripheral non-small cell lung cancer: an initial clinical experience