Robotic Bronchoscopy Proves Safe for Lung Lesion Sampling
Robotic-assisted bronchoscopy showed safe navigation in significant number of most patients with peripheral pulmonary lesions needing a bronchoscopic diagnosis, with a diagnostic yield of 61.6% and minimal adverse events.
METHODOLOGY:
Researchers conducted a prospective observational study across 21 sites in the United States and Hong Kong to assess the safety, navigational success, and diagnostic yield of robotic-assisted bronchoscopy in patients with peripheral pulmonary lesions.
They included 679 patients (median age, 69 years; 55.4% women) with lung lesions measuring 8-50 mm who underwent robotic- assisted bronchoscopy from December 2019 to September 2022.
The primary composite endpoint was at least one incidence of device- or procedure-related adverse events such as pneumothorax requiring intervention, bleeding, or respiratory failure.
Key secondary endpoints were confirmation of lesions by radial probe endobronchial ultrasound (R-EBUS) and diagnostic yield.
TAKEAWAY:
Device- or procedure-related adverse events occurred in 3.8% of patients, with pneumothorax requiring intervention being most common at 2.8%, followed by bleeding events of grade 2 at 0.9%. None of the patients experienced respiratory failure of grade 4 or higher.
Robotic-assisted bronchoscopy provided access to lesions in 98.7% of cases, with lesions confirmed by R-EBUS in 91.7% of patients. The procedure demonstrated a malignancy detection sensitivity of 78.8%.
The overall diagnostic yield of the procedure was 61.6% (95% CI, 57.9%-65.2%), which varied by lesion characteristics: 68.8% for lesions measuring > 20 mm, 56.2% for lesions measuring < 20 mm, and 66.7% when a bronchus sign was present.
Predictors of a higher diagnostic yield were a history of chronic obstructive pulmonary disease/emphysema, the presence of a bronchus sign, a lesion size of > 20 mm, and a higher probability of malignancy.
IN PRACTICE:
'This study is the largest RAB [robotic-assisted bronchoscopy] study to date and includes academic and community centers, providing generalizable estimates of safety and effectiveness in real-world clinical practice,' the authors wrote.
SOURCE:
This study was led by Septimiu Murgu, MD, University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care Medicine, Chicago. It was published online on April 27, 2025, in CHEST.
LIMITATIONS:
This was a single-arm observational study. The investigators had varying levels of experience with robotic-assisted bronchoscopy, and decision-making processes were not uniform across sites. The small number of cone-beam computed tomography users limited meaningful interpretation of the diagnostic yield linked to this technology.
DISCLOSURES:
This study was supported by Auris Health, Inc, part of Johnson & Johnson MedTech. Few authors reported receiving research support from Auris Health and/or Johnson & Johnson MedTech while some reported being currently employed by subsidiaries of Johnson & Johnson.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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