Robotic Bronchoscopies: What They Are and How They Will Change the Future for Lung Cancer

There have been considerable improvements over the past couple of years in the area of obtaining a diagnosis for patients with lung cancer. The ability to get into a very small portion of the lung through robotic bronchoscopies has allowed the patient to get treatment sooner with more specificity, as well as decreased waiting time to get a diagnosis and treatment. Specialties Pulmonary Knowledge

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Robotic Bronchoscopies: What They Are and How They Will Change the Future for Lung Cancer

In the past 15 years, the use of EBUS (Endobronchial ultrasound) and Navigation has enabled doctors to do biopsies and needle aspirations of hard-to-reach tumors and lymph nodes in the lungs. In the last couple of years, robotic bronchoscopy has combined these therapies and improved it so that now it is possible to get lesions that are near a blood vessel or deep in the lung2.

Physicians have been able to find lung lesions earlier in the past ten years because of low-dose CT scans and lung cancer screenings. Routine lung cancer screenings are able to discern how much patients have smoked and for how many years and are taken into consideration. Those who have smoked more than 20 packs of cigarettes in a year, smoke now, or has in the past 15 years, and are between the ages of 50-80 can be a candidate for a CT scan.

There are some lung lesions that are found when a doctor is looking for something else. Unfortunately, many of these patients often don't follow up to determine if it is lung cancer.

The problem with lung cancer (as seen in many other cancers) is that it does not have symptoms until the cancer is advanced. Once a patient is diagnosed, then the robotic system allows for a quicker and more accurate diagnosis.

Robotic surgery gained FDA approval in March of 2018 for use in bronchoscopies1. However, the field of robotics in surgery began in the mid-1980s with CT-guided neurosurgical biopsies, and robotic surgery has spread into many surgical areas such as gynecological, general, urological, cardiac, and thoracic1. There are two systems that are presently used for Robotic bronchoscopies; the Intuitive robotic-assisted ION platform, and the Monarch platform by Auris Health.

In general, the robotic system allows the doctor to use a separate platform controller that they can then manipulate the super thin/flexible scope into the space that they need to get a biopsy2. With a regular bronchoscopy, the doctor holds the scope with one hand, and the other is directing the EBUS, performing a biopsy. With the robotic system, there is more freedom because the robotic arm holds the scope in place, allowing the doctor to use both hands to operate the controls2.

The Ion Endoluminal Platform by Intuitive uses a 3D map with the assistance of a CT scan like the Navigation systems3. Once the patient gets the CT, then the system can create the map of the lung and the route to enable the doctor to get a sample of the tumor3. The tumor can be marked with dye so that it can be easily located during surgical removal3.

The Monarch platform by Auris Health has a four-way steering control, navigation and continuous peripheral visualization while doing the navigation1.

The new robotic bronchoscopies allow the doctor to visualize more of the distal airways and obtain a better sample for pathology. This method will lead to improved outcomes and can decrease the delay of care.

Robotic bronchoscopy systems have many advantages for patients and their doctors. There is supplementary control for the doctor who can guide the scope into very narrow areas in the lungs. The telescoping aspect holds the scope in the airway while the doctor takes a biopsy or flushes with normal saline without having to juggle the scope, the instruments, and the syringes. The advantage for the patient is that it decreases the number of possible procedures/surgeries and can mean that treatment can begin sooner. A patient's anxiety can be lessened due to the fact that they may have a diagnosis sooner and begin treatment earlier.

The future of robotic bronchoscopy is exciting. Advances are being made towards using these procedures to treat tumors directly with radiation, heat, cold, and radiofrequency ablation2. Some of these treatments have been used in the past, but this will allow for increased accuracy. 

Does your facility use the new robotic bronchoscopy system? And, what has this meant for your patients?


References/Resources

Robotic bronchoscopy for pulmonary lesions: a review of existing technologies and clinical data: Journal of Thoracic Disease/National Library of Medicine

Robotic bronchoscopy offers minimally invasive, earlier lung cancer diagnosis: The University of Texas Southwestern Medical Center

UC Davis Health performs first robotic-assisted bronchoscopy procedure: UC Davis Health

Gastrointestinal Columnist

Brenda F. Johnson, BSN, RN Specialty: 25 years of experience in Gastrointestinal Nursing

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Specializes in ICU.

I appreciate the use of new measures to treat patients. Robotics for me is very interested to watch and I've been to mostly being used for bowel procedures at my hospital.

I believe if this leads to patient to a better outcomes in a quicker time - it is a win. Risks of these procedures need to continue to be reviewed, but these methods seem to help physicians and patients ?