Robotic bronchoscopy enables pulmonologists to diagnose lung cancer earlier

By Bharat Bhandari, MD, interventional pulmonology and critical care medicine

New robotic bronchoscopy technology available at ProHealth Waukesha Memorial Hospital is allowing interventional pulmonologists to diagnose lung cancer safely and accurately at an earlier stage, and with fewer complications and significantly less discomfort than some traditional diagnostic modalities.

In the past, when pulmonary nodules were detected as part of lung cancer screening or incidentally on chest imaging, and biopsy was recommended, there were three standard options: a needle biopsy, traditional navigational bronchoscopy, or surgical biopsy performed using video-assisted thoracic surgery (VATS).

The needle biopsy and traditional navigational bronchoscopy are both minimally invasive options. However, the traditional navigational bronchoscopy has a lower detection rate, and the needle has a higher risk of lung collapse. In contrast, the surgical approach is complex and invasive, requires hospital admission and is typically used as a therapeutic procedure and not primarily for diagnosis.

Now the ProHealth team can offer a fourth option — robotic bronchoscopy, using the Ion Robotic Bronchoscopy system from Intuitive Surgical. The platform features a very thin, remotely controlled catheter that enters the body through the mouth to the peripheral lungs. The integration of a cone-beam CT scanner provides real-time imaging guidance, enhancing precision and significantly improving detection rates.

The patient’s CT scan is uploaded into the system software to generate a virtual map of the target lesion. The catheter then navigates along a preplanned, GPS-like pathway. Using a controller similar to a gaming console, the physician precisely directs the catheter to the lung nodule or lesion. An advanced navigation interface, together with an illuminated vision probe, provides turn-by-turn guidance throughout the procedure.

The robotic system features shape-sensing technology to track the catheter’s exact position and shape hundreds of times each second. This innovation delivers the accuracy and stability needed to allow physicians to biopsy small nodules located in the narrow, winding airways at the outer edges of the lungs, spots that are traditionally challenging to reach.

Once a lesion is located, a minimally invasive biopsy is performed to determine whether the lesion is lung cancer. The catheter’s flexible, steerable tip enables the physician to take multiple tissue samples from various angles. Collecting samples from different parts of the nodule helps improve diagnostic accuracy, supports the identification of lung cancer and may allow for biomarker testing to learn whether specific genetic changes are present.

Robotic bronchoscopy normally requires general anesthesia and is performed as an outpatient procedure. In a study comparing robotic biopsies with CT-guided needle biopsy, the robotic cases had comparable biopsy performance but a significantly lower rate of lung collapse.

The diagnosis of lung cancer is often delayed because early symptoms are dismissed as signs of common respiratory conditions. Contact your primary care provider if you experience a cough that worsens over time or does not go away; chest pain when you cough, laugh or inhale deeply; shortness of breath or wheezing; or cough up blood.

The early detection of lung cancer markedly improves patient outcomes, leading to a quicker path towards recovery.