Robotic-Assisted Bronchoscopy
摘要
Robotic-assisted bronchoscopy (RAB) is a revolutionary approach that replaces navigational bronchoscopy for evaluating solitary lung nodules. It offers enhanced maneuverability and stability for accessing challenging areas. There are two RAB platforms currently in the market, the Ion and Monarch. Preprocedural computed tomography (CT) scans of chest are used for mapping the pathways and planning of the route. Both platforms feature four-way steering controls of the bronchoscope attached to the robot arms. The RAB bronchoscopes possess smaller diameters compared to regular bronchoscope, allowing access to more distal airways. The Monarch bronchoscope boasts a larger 4.2 mm diameter, providing continuous vision. On the other hand, the Ion bronchoscopes has a smaller 3.5 mm diameter, requiring removal of the vision probe to insert the biopsy catheter. Sensitivity for diagnosing lung cancer using the Ion and Monarch platforms ranges from 68% to 82% and 71% to 88%, respectively. This is only marginally better than traditional electromagnetic navigational bronchoscopy’s 77% sensitivity. An ongoing limitation is CT-to-body divergence. To address this, real-time imaging modalities such as R-EBUS, augmented fluoroscopy, and cone beam CT are combined with RAB. The use of cone beam CT has shown to increase the sensitivity of RAB to 91.7%. Therapeutically, RAB facilitates the marking of nodule targets to guide surgical resection.