Robotic Endoscopic Airway Challenge: REACH Assessment

Area of Science:

• Pulmonary Medicine
• Medical Robotics
• Diagnostic Imaging

Background:

• Bronchoscopy is crucial for diagnosing peripheral pulmonary lesions.
• Conventional bronchoscopes face limitations in reaching distal airways for biopsy.
• Advancing instruments into peripheral lung segments remains a clinical challenge.

Purpose of the Study:

• To compare the reach of a novel robotic endoscopic system against conventional thin bronchoscopes in human cadaveric lungs.
• To evaluate the system's ability to access peripheral pulmonary structures.
• To assess potential improvements for peripheral lesion biopsy.

Main Methods:

• A robotic endoscope and a conventional thin bronchoscope of identical outer diameter were used.
• Both systems were advanced through all segmental bronchi (RB1-10, LB1-10) in two human cadavers.
• Bronchus generation count and insertion depth were measured using electromagnetic navigation and fluoroscopy.

Main Results:

• The robotic endoscope consistently advanced further into the lung periphery than the conventional bronchoscope.
• Significant differences in reach were observed, particularly in highly angulated bronchi (e.g., RB1, LB1+2).
• The robotic system achieved a mean generation count of 8 in RB1 and LB1+2, compared to 3.5 and 4.5 for the conventional scope.

Conclusions:

• The robotic endoscopic system demonstrated enhanced reach into the periphery of human cadaveric lungs.
• This improved access may overcome limitations of current bronchoscopic techniques for peripheral lesion biopsy.
• Robotic bronchoscopy shows promise for more effective peripheral pulmonary lesion diagnosis and treatment.