Interventional Bronchoscopy Research Articles

Rigid bronchoscopic intervention for malignant central airway obstruction: A narrative review

As the overall survival of patients with cancer has increased over the past decade, the need for bronchoscopic intervention to resolve malignant central airway obstruction (MCAO) has correspondingly increased. The response to chemotherapy and radiotherapy is slow and cannot be guaranteed to adequately address MCAO. Surgery is often impossible because of the extent of disease or the poor performance status of patients. Bronchoscopic intervention results in immediate therapeutic response and is considered safe. Accordingly, many interventional pulmonologists and oncologists are interested in this field, but it is challenging and detailed techniques are not properly standardized, which are barriers to entry into this field. This review aimed to explore the indications and clinical applications of bronchoscopic intervention for patients with MCAO using previously reported data and representative cases from our pioneering experiences. In particular, we focused on rigid bronchoscopy for MCAO, excluding procedures for fistulas or radiation-induced bronchitis stenosis that occurred secondary to anti-cancer treatment.

Simulation on human respiratory motion dynamics and platform construction

Bronchoscopy has a crucial role in the current treatment of lung diseases, and it is typical of interventional medical instruments led by manual intervention. The scientific study of bronchoscopy is now of primary importance in eliminating problems associated with manual intervention by scientific means. However, for its intervention environment, the trachea is often treated statically, without considering the effect of tracheal deformation on bronchoscopic intervention during respiratory motion. Therefore its findings can deviate from practical application. Thus, studying kinetic problems in respiratory motion is of great importance. This paper developed a mathematical model of mechanical properties of respiratory motion to express respiratory force from the perspective of dynamics of respiratory motion. The dynamical model was solved using MATLAB. Then, a finite element model of respiratory motion was built using Mimics, and the results of respiratory force solution were used as the load of model for dynamics simulation in ABAQUS. Then, a human–computer interaction platform was designed in MATLAB APP Designer to realize parametric calculation and fitting of respiratory force, and a personalized human respiratory motion dynamics simulation was completed in conjunction with ABAQUS. Finally, experimental validation of the interactive platform was performed using pulmonary function test data from three patients. Validation analysis by respiration striving solution, kinetic simulation and experiment found that Dynamical model and simulation results can be better adapted to the individualized study of human respiratory motion dynamics.

Effectiveness of combined use of formoterol fumarate tablets and interventional bronchoscopy in the treatment of central airway tumor

Purpose: To study the effectiveness of formoterol fumarate tablets when used in combination with interventional bronchoscopy for central airway tumor.Methods: A total of 154 central airway tumor patients on admission in Second Affiliated Hospital of Zunyi Medical University, Zunyi, China (August 2020 - December 2022) were assigned to benign group (BG, n = 70) and malignant group (MG, n = 84), based on the nature of tumor lesion. The patients were administered formoterol fumarate tablets as well as interventional bronchoscopy. Clinical efficacy, lung function indices such as forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio, blood gas indices (pH, partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2)), scores on shortness of breath, and survival rate, were determined and compared between the two groups.Results: The overall effectiveness in BG (97.14 %) was significantly higher than that in MG (84.52 %). There were higher post-treatment values of FEV1, FVC and FEV1/FVC; higher values of pH and PaO2, lower PaCO2, and lower scores on shortness of breath in BG and MG, relative to pre- treatment levels (p < 0.05). Follow-up showed no recurrence in patients with benign tumor, and clinical efficacy was satisfactory. The 2-year survival rate of patients with malignant tumor was 51.19 %.Conclusion: The combination of formoterol fumarate tablets and interventional bronchoscopy produces significant curative effect on benign and malignant tumor in central airway. It improves lung function, blood gas indices and survival rate, and mitigates shortness of breath. Therefore, this treatment strategy has a high potential for use in clinical practice.

Etiology and clinical features of infection-associated plastic bronchitis in children

ObjectiveTo investigate the etiological characteristics of plastic bronchitis (PB) caused by pulmonary infections in children and to identify any differences in the clinical features of PB cases caused by different pathogens.MethodWe collected data on children diagnosed with PB and admitted to the Respiratory Department at Soochow University Children’s Hospital between July 2021 and March 2023 utilizing electronic bronchoscopy. We analyzed clinical characteristics and the species of pathogens causing the illness in these children.ResultA total of 45 children were enrolled. The main clinical symptoms observed were cough (100%), fever (80%), shortness of breath (28.9%), and wheezing (20.0%). Pathogens were identified in 38 (84.4%) patients. Mycoplasma pneumoniae (MP) had the highest detection rate at 53.3%, followed by the Boca virus at 26.7%. MP-induced PB typically occurs in older children with an average age of 7.46 ± 2.36 years, with the main symptoms including high fever (85.7%) and local hyporespiration (42.9%). In contrast, Boca virus-induced PB tends to occur in younger children, with the main symptoms of moderate fever (54.5%), and wheezing (54.5%). The MP group exhibited a higher incidence of both internal and external pulmonary complications, including pleural effusion (42.9%), elevated aspartate aminotransferase (52.4%), lactic dehydrogenase (76.2%), and D-D dimer (90.5%). Conversely, the Boca virus group primarily showed pulmonary imaging of atelectasis (81.8%), with no pleural effusion. The average number of bronchoscopic interventions in the MP group was 2.24 ± 0.62, which was significantly higher than that required in the Boca virus group (1.55 ± 0.52). During the second bronchoscopy, 57.1% of children in the MP group still had visible mucus plugs, while none were observed in the Boca virus group.ConclusionMP and Boca virus are the primary pathogens responsible for PB among children. The clinical manifestations of PB typically vary significantly based on the pathogen causing the condition.

Benign inoperable tracheal stenosis in COVID versus non-COVID patients at the pandemic epicenter: a case series.

The COVID-19 pandemic has exponentially expanded the number of patients requiring treatment for chronic respiratory failure. One consequence is an increase in the number of patients requiring intubation and mechanical ventilation. Benign inoperable tracheal stenosis presents a challenge, especially in COVID-19 patients. We describe a case series of 15 patients with Benign inoperable tracheal stenosis treated with interventional bronchoscopy over a 15-month period. These patients were divided into two groups, COVID and non-COVID. We used an electrocautery snare as an electrocautery knife to cut the stenotic segment followed by four injections of 1mg submucosal Decadron via a Wang needle. Patients were subsequently followed by the pulmonary clinic. Institutional review board approval was not required as per our institutional policy for a retrospective case series. There was a high degree of success with this intervention, with a low rate of recurrence. We also noticed the following differences between the two subgroups. COVID tracheal stenosis was longer in length, had a higher percentage of cartilage involvement, and was located more distal to cords than the non-COVID group. The median age was younger in the COVID group. COVID pandemic an enormous number of intubations and tracheotomies have been performed. As a result, there will be an increased prevalence of tracheal stenosis. Most of these cases can be effectively treated with surgery. Dealing with complex inoperable cases remains a dilemma. Our case series/research article is an attempt to provide an easy technique with a high cure rate.

Tumor-Related Factors Affecting the Success of Interventional Bronchoscopy in Malignant Airway Obstructions.

It is difficult to select patients who will benefit from endobronchial treatment (ET) in malignant central airway obstruction (MCAO). We aimed to determine the tumor-related factors that affect the success of MCAO treatment. ETs for MCAO between March 2019 and June 2021 were analyzed retrospectively. The relationships between the success of the procedure and the percentage of endoluminal obstruction, tumor size, and type of lesion were evaluated. Totally, 220 ETs were administered to 205 patients. Treatment was significantly more successful for the patients with pure endobronchial lesions than those with mixed lesions. The success rate was significantly lower when the tumor size was greater than 54.5 mm and the degree of endoluminal stenosis exceeded 92%; the area under the curve was 0.734 (0.625-0.842; P=0.001) and 0.733 (0.597- 0.870; P=0.001), respectively. There was no difference in the procedural success between lung cancer and extrathoracic malignancies and tumor treatment before the procedure. Mixed lesions, tumor size over 54.5 mm, and a degree of stenosis over 92% are risk factors for unsuccessful endoluminal obstruction procedures. These parameters should be considered when selecting patients for ET interventions.

Bronchoscopist-Directed Continuous Flow Propofol Based Analgosedation during Flexible Interventional Bronchoscopy and EBUS.

Sedation techniques in interventional flexible bronchoscopy and endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) are inconsistent and the evidence for required general anesthesia under full anesthesiologic involvement is scarce. Moreover, we faced the challenge of providing bronchoscopic care with limited personnel. Hence, we retrospectively identified 513 patients that underwent flexible interventional bronchoscopy and/or EBUS-TBNA out of our institution between January 2020 and August 2022 to evaluate our deep analgosedation approach based on pethidine/meperidine bolus plus continuous flow adjusted propofol, the bronchoscopist-directed continuous flow propofol based analgosedation (BDcfP) in a two-personnel setting. Consequently, 502 out of 513 patients received BDcfP for analgosedation. We identified cardiovascular comorbidities, chronic obstructive pulmonary disease, and arterial hypertension as risk factors for periprocedural hypotension. Propofol flow rate did not correlate with hypotension. Theodrenaline and cafedrine might be used to treat periprocedural hypotension. Moreover, midazolam might be used to support the sedative effect. In conclusion, BDcfP is a safe and feasible sedative approach during interventional flexible bronchoscopy and EBUS-TBNA. In general, after the implementation of safety measures, EBUS-TBNA and interventional flexible bronchoscopy via BDcfP might safely be performed even with limited personnel.

Paediatric foreign body aspiration and endobronchial granuloma.

Paediatric foreign body aspiration can result in pulmonary complications including the formation of endobronchial granuloma, which can be managed conservatively or via surgical or bronchoscopic intervention. This case highlights the importance of having a high index of suspicion for foreign body aspiration in patients with persistent symptoms or abnormal imaging.

Tracheal Stenosis and Airway Complications in the Coronavirus Disease 2019 Era

BackgroundSevere coronavirus disease 2019 (COVID-19) infection is associated with prolonged intubation and its complications. Tracheal stenosis is 1 such complication that may require specialized surgical management. We aimed to describe the surgical management of post–COVID-19 tracheal stenosis. MethodsThis case series describes consecutive patients with tracheal stenosis from intubation for severe COVID-19 infection at our single, tertiary academic medical center between January 1, 2021, and December 31, 2021. Patients were included if they underwent surgical management with tracheal resection and reconstruction (TRR) or bronchoscopic intervention. Operative through 6-month symptom-free survival and histopathologic analysis of resected trachea were reviewed. ResultsEight patients are included in this case series. All patients are female, and most (87.5%) are obese. Five patients (62.5%) underwent TRR; 3 patients (38.5%) underwent non–resection-based management. Among patients who underwent TRR, 6-month symptom-free survival is 80%; 1 patient (20%) required tracheostomy after TRR for recurrent symptoms. Of the 3 patients who underwent non–resection-based management, 2 (66.7%) experienced durable relief from symptoms of tracheal stenosis with tracheal balloon dilation; the remaining patient required laser excision of tracheal tissue before experiencing symptomatic relief. ConclusionsThe incidence of tracheal stenosis may increase as patients recover from severe COVID-19 infection requiring intubation. Management of tracheal stenosis with TRR is safe and effective, with comparable rates of success to TRR for non–COVID-19 tracheal stenosis. Non–resection-based management is an option to manage tracheal stenosis in patients with less severe stenosis or in poor surgical candidates.

TOTAL LUNG COLLAPSE TREATED WITH EFFECTIVE PHYSIOTHERAPY AND PHARMACOTHERAPY

Acute mucus plugging causing lung collapse is an emergency associated with increased mortality specially in patients with impaired cough reflex. Bronchoscopic interventions are often required in emergency to relieve the patient however mechanical percussive chest physiotherapies may be helpful. We discuss a case of a patient who developed respiratory distress rapidly; a chest radiograph revealed right lung atelectasis suggesting acute mucus plugging, confirmed by HRCT thorax. Bedside chest physiotherapy was started along with preparing for bronchoscopy. Clinical improvement was observed. Chest x-ray was repeated before going for bronchoscopy which revealed resolution of collapse hence procedure was not done. Our case illustrates the utility of chest physiotherapy and mucolytics in resolving the lung collapse due to acute mucus plugging in an urgent scenario in high-risk patients with recent history of head and neck surgery

Interventional Bronchoscopy in Children: The Way Forward.

Bronchoscopy in children has been utilized primarily to diagnose airway anomalies and obtain bronchoalveolar lavage. Gradual development of thinner bronchoscopes and instruments has opened the gates to the world of bronchoscopic interventions in children. Endobronchial ultrasound guided mediastinal aspiration has been used in adults and children. In younger children, esophageal approach has also been used for sampling of mediastinal lymph nodes. Lung biopsies using cryoprobe have been increasingly used in children. Other bronchoscopic interventions discussed include dilatation of tracheobronchial stenosis, airway stenting, foreign body removal, hemoptysis control, re-expansion of atelectasis etc. Patient safety during the procedure is of paramount importance. Expertise and availability of equipment to handle complications is of huge significance.

Rigid Bronchoscopy for Post-Tuberculosis Tracheobronchial Stenosis.

The healing process of tracheobronchial tuberculosis (TB) result in tracheobronchial fibrosis causing airway stenosis in 11-42% of patients. In Korea, where pulmonary TB is still prevalent, post-TB tracheobronchial stenosis (PTTS) is one of the main causes of benign airway stenosis causing progressive dyspnea, hypoxemia and often representing life-threatening respiratory insufficiency. The development of rigid bronchoscopy replaced surgical management since last 30 years, and nowadays PTTS is mainly managed by bronchoscopic intervention in Korea. When diagnosed, tracheobronchial TB is treated by combination of anti-TB medications as other pulmonary TB. The indication of rigid bronchoscopy is more than ATS grade 3 dyspnea in PTTS patients. At first narrowed airway is dilated by multiple techniques, including ballooning, laser resection, bougienation under general anesthesia. Then, most of patients need silicone stenting to maintain the patency of dilated airway. 1.5~2 years after indwelling, the stent could be removed with 70% of success rate. Acute complications develops in less than 10% of patients without mortality. Subgroup analysis showed successful removal of stent was significantly associated with male sex, young age, good baseline lung function and absence of complete one lobe collapse. In conclusion, rigid bronchoscopy could be applied to PTTS patients with acceptable efficacy and tolerable safety.

The bleeding risk and safety of multiple treatments by bronchoscopy in patients with central airway stenosis

Background Central airway obstruction (CAO) are common abnormality that usually needing interventional bronchoscopy, and sometimes multiple rounds of treatment. However, there were few studies explore the safety of it. Research design & methods The records of patients who underwent interventional bronchoscopy because of CAO at Respiratory department between January 1, 2010, and December 31, 2020 were revised. The patients’ clinical characteristics, information about bronchoscopy and incidence of complications were collected and analyzed. Results There were totally 1,482 bronchoscopy procedures conducted in the 733 CAO patients. And the incidence of major complications in the retreatment group was significantly lower than that in the first treatment group ((4.77% vs. 1.87%, χ2=9.78, df=1, p<0.01), so did the incidence of severe bleeding (2.46% vs. 0.40%, χ2=11.20, df=1, p<0.01). However, there was some variability between the two groups in age and anesthesia type. A short interval time, more treatment times, and general anesthesia were related to a lower incidence of hemorrhage. For patients who were previously bleeding, the incidence of hemorrhage was significantly higher than the incidence in the non-bleeding patients (42.93% vs. 16.33%, respectively; χ2=57.54, df=1, p<0.01). Conclusion For the patients with CAO, repeated interventional bronchoscopy treatment was safe, and it should be treated with discretion when retreat the patients once bleeding during previous therapeutic bronchoscopy.

Immediate and Follow-up Imaging Findings after Cone-Beam CT–guided Transbronchial Lung Cryobiopsy

To evaluate findings after transbronchial lung cryobiopsy (TBLC) using intraprocedural cone-beam CT (CBCT) and follow-up chest CT examinations. A single-center, prospective cohort study was performed with 14 participants (mean age, 65 years ± 13 [SD]; eight male participants) undergoing CBCT-guided TBLC between August 2020 and February 2021 who underwent follow-up chest CT imaging. Intraprocedural CBCT and follow-up chest CT images were interpreted for changes compared with baseline CT images. Statistical analyses were performed using independent samples t test and analysis of variance. A total of 62 biopsies were performed, with 48 in the field of view of CBCT immediately after biopsy. All 48 biopsy sites had evidence of postprocedural hemorrhage, and 17 (35%) had pneumatoceles at the biopsy site. Follow-up CT images showed resolution of these findings. Solid nodules developed at 18 of the 62 (29%) biopsy sites. Postbiopsy hemorrhage and pneumatoceles on intraprocedural CBCT images (which were clinically occult and resolved spontaneously) and new solid nodules on follow-up chest CT images were commonly observed after TBLC. These findings may help alleviate unnecessary follow-up imaging and tissue sampling.Keywords: Biopsy/Needle Aspiration, CT, Lungs, Lung Biopsy, Interventional Bronchoscopy© RSNA, 2023.

Long-term follow up and comparison between conservative and interventional therapy in postoperative bronchopleural fistula-a cohort study.

Bronchopleural fistula (BPF) is a relatively rare postoperative complication with high mortality. The management is tough and controversial. The aim of this study was to compare the short and long-term outcomes between the conservative and the interventional therapy in postoperative BPF. We also concluded our own strategy and experience of treatment in postoperative BPF. Postoperative BPF patients with malignancies, aged from 18 to 80 years old who had undergone thoracic surgery between June 2011 and June 2020, were included in this study and followed up from 20 months to 10 years. They were retrospectively reviewed and analyzed. Ninety-two BPF patients were included in this study, 39 of whom underwent interventional treatment. Significant differences were found in the 28-day and the 90-day survival rates between the conservative and the interventional therapy (P=0.001, 43.40% vs. 76.92%; P=0.006, 35.85% vs. 66.67%). Simple conservative therapy was independently associated with 90-day mortality between the groups in postoperative BPF [P=0.002, hazards ratio (HR) =2.913, 95% confidence interval (CI): 1.480-5.731]. Postoperative BPF is notorious for its high mortality. Surgical and bronchoscopic interventions are recommendable in postoperative BPF as they guarantee better short and long-term outcomes compared with the conservative therapy.

Modern Bronchoscopic Treatment Options for Patients with Chronic Bronchitis.

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death worldwide and has a large impact on a patient's quality of life due to its wide range of symptoms and comorbidities. There are known to be different phenotypes in COPD with various extents on the burden of the disease and its prognosis. Chronic bronchitis with persistent cough and mucus production is regarded as one of the main symptoms of COPD with tremendous effects on subjectively reported symptom burden and frequency of exacerbations. Exacerbations in turn are known to have an impact on disease progression and increase health care costs. Modern bronchoscopic treatment options are currently under investigation targeting the problem of chronic bronchitis and frequent exacerbations. This review summarizes the existing literature about these modern interventional treatment options and provides perspectives on upcoming studies.

The diagnostic performance of endobronchial ultrasound with Xpert MTB/RIF Ultra in smear-negative pulmonary tuberculosis

ObjectiveThis study investigated the diagnostic performance of endobronchial ultrasound with Xpert MTB/RIF Ultra (Ultra) for detecting smear-negative pulmonary tuberculosis (TB).Methods143 patients suspected of sputum smear-negative pulmonary tuberculosis were enrolled in this study in Shanghai Pulmonary Hospital, China. These patients underwent endobronchial ultrasound with a guide sheath (EBUS-GS) or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) based on their chest CT manifestations. We assessed the sensitivity and specificity of tissue specimens with Ultra in the TB group and non-TB group. Culture and clinical diagnosis were used as gold-standard for TB.ResultsAmong these 143 patients, 11 patients were culture-positive TB, 85 patients were diagnosed with culture-negative TB and 47 were with the non-TB diseases. Direct testing with microscopy (Acid-Fast Bacilli smear, AFB), liquid culture, pathology, Xpert MTB/RIF(Xpert) test and Ultra had a sensitivity of 8.3%, 11.5%, 42.7%, 64.6%, and 78.1% individually among all the TB patients. Ultra had a higher sensitivity than Xpert (P = 0.011). But Ultra had a specificity of 59.6% (95% CI 44.3–73.3), lower than that of Xpert (89.4%, 95% CI 76.1–96.0, P = 0.001). Ultra had the same sensitivity on specimens from EBUS-TBNA and EBUS-GS (P = 0.975). Ultra’s positive predictive value and negative predictive value were 79.8% and 57.1% respectively.ConclusionsTissue specimens from interventional bronchoscopy combined with Ultra provide a sensitive method for diagnosing smear-negative pulmonary tuberculosis, but its specificity was lower than Xpert.

Bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis

Objective: To analyze the bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis. Methods: Clinical data of patients with pulmonary mucormycosis undergoing bronchoscopy and interventional therapy in 4 tertiary general hospitals in China from May 2006 to May 2022 were retrospectively analyzed and the literature on the subject were reviewed. Results: The data of 10 patients with pathologically diagnosed pulmonary mucormycosis undergoing bronchoscopy and interventional therapy were collected, including 8 males and 2 females. The patients' age ranged from 21 to 72 (44±15) years. The underlying diseases included 6 cases of diabetes ketoacidosis, 3 cases of leukemia, 1 case after operation of lung cancer. Bronchoscopy showed that white viscous necrotic matters grew along the airway and blocked the airway in 9 cases, accompanied by airway bleeding in 3 cases, bloody secretion blocked the airway in 1 case, and bronchopulmonary cavity fistula in 2 cases. The biopsy histopathology of white necrotic matters showed that many mucor filaments were tangled together which were named mucormycelium. Among the 10 patients, 9 were treated with systemic drugs, including intravenous application of amphotericin B deoxycholate in 5 cases, intravenous application of amphotericin B liposome in 4 cases, oral posaconazole in 6 cases and intravenous injection in 1 case. Local drug therapy included aerosol inhalation of amphotericin B deoxycholate in 8 cases and local perfusion under bronchoscope in 5 cases. Bronchoscopic interventional therapy was used to remove mucormycelium in the bronchus, including cryotherapy in 8 cases, biopsy forceps in 7 cases, snare treatment in 2 cases and foreign body forceps in 2 cases. All 10 patients were clinical cured and with no death. Conclusions: Pulmonary mucormycosis is more common in immunocompromised hosts. Bronchoscopy often showed mucormycelium blocking the airway. Systemic and local drug therapy combined with bronchoscopic interventional therapy can achieve good clinical efficacy.

Characteristics analysis of 157 cases of central airway stenosis due to tracheobronchial tuberculosis: A descriptive study.

Tracheobronchial stenosis, particularly central airway stenosis, which frequently results in severe complications such as lung damage, occurs in patients with tracheobronchial tuberculosis (TBTB). To analyze the clinical characteristics of patients with central airway stenosis due to tuberculosis (CASTB). Retrospective analysis was performed on the clinical features, radiological features, bronchoscopic features and treatment of 157 patients who were diagnosed with CASTB in two tertiary hospitals in Chongqing, China, from May 2020 to May 2022. CASTB mostly occurs in young patients and females. Patients with CASTB exhibited different symptoms repeatedly during the disease, especially varying degrees of dyspnea, prompting many patients to undergo bronchoscopic intervention and even surgery. Patients with cicatricial strictures constituted the highest proportion of the TBTB subtype with CASTB and 35.7% of the patients with CASTB were found to have tracheobronchomalacia (TBM) under bronchoscopy. CASTB and TBM mainly involved the left main bronchus. Patients with lower levels of education had higher rates of TBM. Patients with TBM manifested shortness of breath more frequently than patients without TBM. Patients with TBTB who had undergone bronchoscopic interventions have a higher rate of TBM. Despite mostly adequate anti-tuberculosis chemotherapy, patients with TBTB can present with CASTB involving severe scarring stenosis, bronchial occlusion, tracheobronchomalacia and even destroyed lung.

A Millimeter-Scale Soft Robot for Tissue Biopsy Procedures.

While interest in soft robotics as surgical tools has grown due to their inherently safe interactions with the body, their feasibility is limited in the amount of force that can be transmitted during procedures. This is especially apparent in minimally invasive procedures where millimeter-scale devices are necessary for reaching the desired surgical site, such as in interventional bronchoscopy. To leverage the benefits of soft robotics in minimally invasive surgery, a soft robot with integrated tip steering, stabilization, and needle deployment capabilities is proposed for lung tissue biopsy procedures. Design, fabrication, and modeling of the force transmission of this soft robotic platform allows for integration into a system with a diameter of 3.5 mm. Characterizations of the soft robot are performed to analyze bending angle, force transmission, and expansion during needle deployment. In-vitro experiments of both the needle deployment mechanism and fully integrated soft robot validate the proposed workflow and capabilities in a simulated surgical setting.