Robotic versus Electromagnetic Bronchoscopy for Peripheral Pulmonary Lesions: A Randomized Trial (RELIANT)

Area of Science:

• Pulmonology
• Medical Technology
• Interventional Procedures

Background:

• Robotic-assisted bronchoscopy (RAB) is an emerging alternative to electromagnetic navigational bronchoscopy (EMN) for peripheral pulmonary lesion biopsy.
• Comparative effectiveness data between RAB and EMN are limited, despite their clinical use.

Purpose of the Study:

• To compare the effectiveness of RAB versus EMN for the diagnostic evaluation of peripheral pulmonary lesions.

Main Methods:

• A single-center, cluster-randomized noninferiority trial involving 411 patients undergoing diagnostic bronchoscopy.
• Patients were assigned to either RAB or EMN, with operating rooms serving as the randomization unit.
• Primary outcome was diagnostic yield (lesional tissue acquisition); secondary outcomes included procedure duration and safety.

Main Results:

• Diagnostic yield was 77.8% for RAB (158/203) and 75.5% for EMN (157/208), confirming non-inferiority (P=0.007).
• Median procedure duration was longer for RAB (37 min) compared to EMN (32 min).
• Similar complication rates were observed, with pneumothorax occurring in 4 RAB patients and 6 EMN patients.

Conclusions:

• Robotic-assisted bronchoscopy is not inferior to electromagnetic navigation bronchoscopy in terms of diagnostic yield for peripheral pulmonary lesions.
• The findings support RAB as a viable alternative for diagnosing peripheral lung abnormalities.