What is Robotic-Assisted Bronchoscopy?
Robotic-assisted bronchoscopy is a minimally invasive procedure used to identify lung nodules and help determine whether a lung mass or lung nodule is cancerous. Fort Sanders Regional Medical Center in Knoxville is a leader in lung care and was the first hospital in East Tennessee to implement robotic-assisted bronchoscopy technology as part of the hospital’s Lung Nodule Program. Nearly 1,000 patients underwent robotic-assisted bronchoscopy in the program’s first two-and-a-half years.
Lung cancer is the leading cause of cancer-related deaths worldwide. Routine screening and early detection are critical for identifying and treating lung cancer and boosting the odds for survival.
How Does Robotic Bronchoscopy Help Diagnose Lung Cancer?
Lung nodules are often initially discovered through different types of screenings, including regular or emergency imaging scans. For persons at high risk for lung cancer, low-dose CT scans are considered the optimal screening for earlier detection.
If a lung nodule is growing or is in a hard-to-reach area of the lungs, robotic-assisted bronchoscopy can provide important information. The goals are to identify lung cancer as early as possible and to provide timely treatment.
This technology revolutionizes how we approach lung nodules – it’s like GPS for the lungs. It allows us to reach peripheral areas of the lungs that were difficult or impossible to reach before. Ultimately, we’ll be able to diagnose lung cancer and start treatment earlier, providing more opportunity for a successful outcome.
Varun Shah, MD, interventional pulmonologist
What Happens During Robotic-Assisted Bronchoscopy?
In robotic-assisted bronchoscopy, a pulmonologist (a physician who specializes in lung disorders) uses advanced 3D imaging and a robotic navigational system for the procedure. The physician operates a robotic arm by using a controller at a console. The robotic arm guides a shape-sensing, ultra-thin, ultra-maneuverable catheter (a thin, hollow tube) through the patient’s airways and into the lung. The catheter has a camera and a light, and can find tissue samples of lung nodules in hard-to-reach areas.
The physician controls the robot at all times, navigating to the target along a planned path that’s based on a 3D image of the patient’s lungs and chest area. The catheter can move 180 degrees in any direction to pass through small, difficult-to-navigate airways and around tight bends. The robot’s peripheral vision probe allows the physician to see details in the lung while navigating.
Once the catheter reaches a lung nodule, it locks in place and a flexible biopsy needle follows the bends through the catheter. The needle deploys to retrieve a tissue sample for examination.
Robotic-Assisted Bronchoscopy vs. Traditional Bronchoscopy
In addition to identifying lung cancer, bronchoscopies use a tube called a bronchoscope to diagnose lung problems such as chronic cough, pneumonia, obstructions or blockages, and for follow-up after abnormal chest X-rays.
Robotic-assisted bronchoscopy is used primarily to find and biopsy lung nodules in hard-to-reach areas to identify lung cancer early when it can be treated more effectively. The combination of 3D computerized imaging/mapping and the flexibility of the catheter and biopsy tools allows the pulmonologist to reach lung nodules that previously required more invasive biopsy techniques or surgery. Compared to manual techniques, robotic-assisted bronchoscopy provides additional stability and precision.
Robotic-assisted bronchoscopy can be used in conjunction with a procedure called endobronchial ultrasound (EBUS). This minimally invasive, non-surgical procedure evaluates lymph nodes in the chest to determine whether cancer has spread. The information helps with cancer staging and developing treatment plans.
Lung nodules are often found in difficult-to-access locations. This equipment allows our specialized pulmonologists to obtain an earlier, more accurate diagnosis. Finding lung cancer earlier allows for faster treatment and better patient outcomes.
David B. Graham, MD, thoracic surgeon
Benefits of Robotic-Assisted Bronchoscopy
- Less anesthesia needed
- Improved accuracy
- Less blood loss and pain
- Smaller incisions and reduced scarring
- Shorter length of stay
- Faster recovery and lower risk of infection
Fort Sanders Regional Medical Center’s lung nodule program has a patient-centric, multidisciplinary approach that combines medical expertise and technology like robotic-assisted bronchoscopy with tailored treatment plans and coordinated support resources.
More About Robotic-Assisted Bronchoscopy
Who is Eligible?
If you have a suspicious lung nodule or mass, you may be eligible for robotic-assisted bronchoscopy. If your physician determines the physician would be helpful, you will have some pre-procedure tests to rule out any medical conditions that might increase the risk of complications.
During the Procedure
If you are having a robotic-assisted bronchoscopy, you’ll have CT scans of your chest prior to the procedure to help your pulmonologist locate the nodule(s) in your airway. The robotic-assisted system will create a virtual 3D image of your lungs and airways to help the physician navigate to the nodule.
Patients receive sedative medicines and numbing gels or sprays prior to the procedure. After you’re sedated, the pulmonologist inserts a flexible catheter through your endotracheal tube. The pulmonologist steers the catheter and is in control of the robot at all times. Like a GPS system, imaging allows your physician to pinpoint the catheter’s location in your body. The physician steers the catheter in a pre-mapped path from your CT scan.
Once the physician reaches the target nodule, biopsy tools are used to take tissue samples from the nodule. A pathologist may look at the tissue under a microscope and provide feedback. The physician can biopsy the nodule from different angles if more tissue samples are needed.
After the Procedure
Patients receive a follow-up X-ray after robotic-assisted bronchoscopy. You will usually go home the same day as your procedure. You will need to wait until any numbing medications wear off before eating or drinking, but otherwise there are typically no restrictions.
You may experience a sore throat, hoarseness, nausea, fever or cough after your biopsy, but these aftereffects are temporary.
Risks of Robotic-Assisted Bronchoscopy
Serious complications such as significant airway bleeding or collapsed lung are very rare (for example, less than one percent for collapsed lung). Robotic-assisted bronchoscopy does not involve any incisions and has a lower risk of complications than surgery.
A physician referral is needed for robotic-assisted bronchoscopy. If you are at high risk for lung cancer because of long-term smoking or exposure to environmental toxins, talk with your medical provider about a referral for low-dose CT screenings. If you have a suspicious lung nodule or mass, you may benefit from robotic-assisted bronchoscopy. Learn more about Fort Sanders Regional’s lung nodule program, including our multidisciplinary approach with our patient navigator and physician team. For more information call 865-331-2222.
