ROBOTIC-ASSISTED BRONCHOSCOPIC BIOPSY OF PERIPHERAL PULMONARY LESIONS IN A CADAVERIC MODEL WITH SIMULATED TUMOR TARGETS

Abstract

SESSION TITLE: Late Breaking Abstracts SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 04:30 PM - 05:30 PM PURPOSE: Successful biopsy of peripheral pulmonary lesions continues to present clinical challenges, particularly for pulmonary nodules 1-3cm in size. Despite the introduction of advanced image guided techniques, no singular approach has demonstrated consistently high yields. Robotic bronchoscopy has recently been described as a novel approach towards peripheral lesion biopsy, and preliminary studies have demonstrated improved peripheral reach in cadaveric human lungs compared with conventional thin bronchoscopes despite having similarly sized outer diameters. Along with improved access to the lung periphery, one potential benefit of robotic systems may be improved stability and control when performing biopsies of peripheral lesions. To evaluate this, robotic bronchoscopy was performed in cadaveric human lungs which had been implanted with simulated tumor targets to assess the robotic platform's precision with peripheral lesion biopsy. METHODS: Each cadaver was injected with a minimum of 8 simulated tumor targets composed of gelatin, agar, contrast material and pigmented mica powder. Following target injection, all cadavers underwent computed tomography (CT) which was used to provide lesion characteristics such as size and location as well as to assist with navigation towards peripheral lesions. Robotic bronchoscopy was performed by one operator per cadaver. The robotic endoscopic system (RES) (Monarch, Auris Health, Redwood City, CA) was navigated to peripheral lesions using a combination of electromagnetic navigational guidance and radial probe endobronchial ultrasound confirmation of target lesion localization. Following lesion localization, biopsies were performed using transbronchial needle aspiration and transbronchial biopsy. Biopsy specimens were evaluated using a microscope for the presence or absence of pigmented powder and were classified as diagnostic when pigment was present, and non-diagnostic when pigment was absent. RESULTS: Sixty-seven nodules were prepared in 8 human cadaveric lungs. Nodules were distributed in all lobes of the lung and mean size as measured in longest cross sectional diameter on axial CT scan was 2.4cm (range 0.9-2.8cm). 46/67 (68%) of nodules were less than 2cm in size and 21/67 (31%) were 2-3cm in size. Nineteen percent of nodules identified with radial EBUS demonstrated a concentric view and 81% of nodules demonstrated an eccentric view. A diagnosis was confirmed in 65/67 (97%) of nodules. CONCLUSIONS: Robotic bronchoscopy successfully obtained a diagnosis in 97% of lesions in human cadaveric lungs with implanted tumor targets 1-3cm in size. Future studies will be performed to validate these findings in live human subjects with peripheral lesions. CLINICAL IMPLICATIONS: Robotic bronchoscopy may be a useful platform to assist with establishing a diagnosis in patients with peripheral pulmonary lesions requiring biopsy. DISCLOSURES: Consultant relationship with Olympus Please note: $20001 - $100000 Added 11/29/2017 by Alexander Chen, source=Web Response, value=Consulting fee Investigator relationship with Olympus Please note: $20001 - $100000 Added 11/29/2017 by Alexander Chen, source=Web Response, value=Grant/Research Support Scientific Medical Advisor relationship with Auris Robotics Please note: $5001 - $20000 Added 11/29/2017 by Alexander Chen, source=Web Response, value=Honoraria Consultant relationship with Boston Scientific Please note: $5001 - $20000 Added 11/29/2017 by Alexander Chen, source=Web Response, value=Consulting fee Scientific Medical Advisor relationship with Auris Please note: $1001 - $5000 Added 05/24/2018 by Thomas Gildea, source=Web Response, value=Consulting fee Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 05/30/2018 by Colin Gillespie, source=Web Response, value=Honoraria Educational instructor relationship with Cook Medical Please note: $1001 - $5000 Added 05/30/2018 by Colin Gillespie, source=Web Response, value=Honoraria Advisory Committee Member relationship with CareFusion Please note: $1001 - $5000 Added 05/30/2018 by Colin Gillespie, source=Web Response, value=Honoraria Consultant relationship with Auris Robitics Please note: $1001 - $5000 Added 05/30/2018 by Colin Gillespie, source=Web Response, value=Consulting fee Consultant relationship with Auris Robotics Please note: $1001 - $5000 Added 05/23/2018 by Michael Machuzak, source=Web Response, value=Honoraria No relevant relationships by Amit Mahajan, source=Web Response Consultant relationship with Boston Scientific, Auris, Veracyte Please note: $5001 - $20000 Added 02/01/2018 by Scott Oh, source=Web Response, value=Consulting fee Consultant relationship with Olympus Please note: $1001 - $5000 Added 11/26/2017 by Nicholas Pastis, source=Web Response, value=Honoraria Consultant relationship with Boston Scientific Please note: $5001 - $20000 Added 11/26/2017 by Nicholas Pastis, source=Web Response, value=Honoraria Consultant relationship with Veran Please note: $5001 - $20000 Added 11/26/2017 by Nicholas Pastis, source=Web Response, value=Grant/Research Support Consultant relationship with Cook Please note: $1001 - $5000 Added 11/26/2017 by Nicholas Pastis, source=Web Response, value=Honoraria research grant relationship with auris Please note: $5001 - $20000 Added 05/24/2018 by Gerard Silvestri, source=Web Response, value=Grant/Research Support No relevant relationships by Michael Simoff, source=Web Response