Abstract
BackgroundThe 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.MethodsWe 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.ResultsOne 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.ConclusionsRAB 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.
Highlights
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
The increasing need to efficiently and safely sample lung lesions has led to the development of virtual bronchoscopy (VB), radial endobronchial ultrasound (r-Endobronchial ultrasound (EBUS)), electromagnetic navigation (EMN), fluoroscopy-based navigation, bronchoscopic trans-parenchymal nodule access (BTPNA), ultrathin bronchoscopes, and cone-beam computed tomography (CBCT) guided-bronchoscopy
Robot-assisted bronchoscopy (RAB) was shown to have improved reach in the periphery of the lung in all segments when compared with 4.2 mm Outer diameter (OD) conventional thin bronchoscopes [8]
Summary
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. Robot-assisted bronchoscopy (RAB) was shown to have improved reach in the periphery of the lung in all segments when compared with 4.2 mm OD conventional thin bronchoscopes (by average generation count: 8.7 vs 5.6) [8]. This may be explained by 1) the improved structural support provided by the outer sheath, that is usually locked in the target segment (usually 3rd-4th generation) before advancing the scope, and 2) the improved ability to make subtle turns due to 4-. This, along with the better column strength and telescoping design, could enable higher diagnostic yields of peripheral lesions
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