Abstract
Research questions. How does a virtual bronchoscopy navigation system (VBNS) improve prediction of candidate bronchus across a range of doctors investigating a range of lesions with Endobronchial ultrasound (EBUS) guide sheath? To what extent do benefits of virtual bronchoscopic pre-procedure navigation apply to experienced versus inexperienced bron- choscopists? Methods: Using archived EBUS Guide sheath cases, a comparison was made between identified candidate 4th order bronchus by Computerised tomography (CT) evaluation versus that identified after virtual path creation. Results: From 7 archived cases, 14 doctors identified the correct bronchus in 94 of 98 assessments (95%). Percentage of cases where there was an improvement in localisation by 2 or more 4th order bronchi was 39.8% overall (28.6% – 51.0%), 26.6 for experienced and 53.1 for inexperienced bronchoscopists (p < 0.02). The absolute mean number of 4th order bronchi different between CT and VBNS was 2.0 ± 2.6 overall, 1.2 (range 0-6) for experienced, and 2.8 (range 0-11) for inexperienced bronchoscopists. Virtual Path software calculation time was 8.1 ± 2.7 minutes, compared to 3.6 ± 2.1 minutes by CT. Conclusion: VBNS allowed rapid accurate assessment with minimal software training. Greatest benefits in reduction of procedure time were obtained in inexperienced bronchoscopists, and VBNS could allow more rapid skill development in EBUS GS in these doctors.
Highlights
Endobronchial Ultrasound Guide sheath (EBUS GS)sampling of peripheral lung nodules is an accepted method in bronchoscopy [1,2]
Research questions: How does a virtual bronchoscopy navigation system (VBNS) improve prediction of candidate bronchus across a range of doctors investigating a range of lesions with endobronchial ultrasound (EBUS) guide sheath? To what extent do benefits of virtual bronchoscopic pre-procedure navigation apply to experienced versus inexperienced bronchoscopists? Methods: Using archived EBUS Guide sheath cases, a comparison was made between identified candidate 4th order bronchus by Computerised tomography (CT) evaluation versus that identified after virtual path creation
In the ore recent Shinagawa study virtual planning did reduce EBUS GS procedure time by approximately 2 minutes- that study was done by 3 experienced bronchoscopists and our study provides unique information about the potential benefit to trainees as well
Summary
Endobronchial Ultrasound Guide sheath (EBUS GS)sampling of peripheral lung nodules is an accepted method in bronchoscopy [1,2]. Finding small peripheral lesions is difficult [3] and EBUS GS has substantially improved procedural yields [4]. The majority identify 5 - 8 branches [9] This information is useful when combined with EBUS GS because the selection of the bronchus is so critical, thereby reducing procedure time. This has been demonstrated in a limited number of centres, usually by operators highly experienced in the field [12,13]. In Asano’s series combining EBUS GS with a CT virtual bronchoscopy navigation system (VBNS) the system automatically produced virtual images to a median of fifth- (third- to seventh-) order bronchi [12]. Shinagawa compared use of VBNS with real time in-procedure tracking with EBUS GS to a historical series of VBNS assisted biopsies where the bronchoscopist had to remember the Published Online December 2011 in SciRes. http://www.scirp.org/journal/OJCD
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