Robotic-Assisted Bronchoscopy to Evaluate a Solitary Peripheral Lung Nodule

A 69-year-old man with chronic obstructive pulmonary disease and a 20-pack-year smoking history was found to have a 20 mm x 8 mm lung nodule concerning for malignancy in the periphery of the right lower lobe. A robotic-assisted bronchoscopy was performed to obtain a tissue diagnosis.

The robotic bronchoscope consists of an inner bronchoscope (4.2 mm diameter) and an outer sheath (6 mm diameter), both with 4-way steering control, and is driven with a handheld controller. It possesses a working port with an inner diameter of 2.1 mm. A specialized (thin-sliced) computed tomography scan is required for 3D reconstruction of the tracheobronchial tree and electromagnetic navigation during the procedure. The stability of the robotic bronchoscope allows for exchange of biopsy tools via the working port while the robot maintains its position of direct vision at the target lesion.

The patient was intubated for general anesthesia. Patient sensors were placed on the chest wall with an electromagnetic field generator adjacent to the thorax. Traditional bronchoscopy was first performed to assess major airways, clear secretions, and confirm proper placement of the endotracheal tube for the robotic-assisted procedure. The robot was docked to the endotracheal tube stabilization device. The outer sheath was navigated to a segmental airway in the right lower lobe. The inner bronchoscope was advanced to the target lesion under the guidance of direct vision and electromagnetic navigation. Sampling tools were placed through the working channel. Right lower lobe needle aspiration, cytology brush, forceps, and bronchoalveolar lavage were performed. Postoperative chest X-ray showed no pneumothorax. The patient was discharged the same day without complication from the procedure. Pathology demonstrated squamous cell carcinoma.