Comparing Monarch Versus Ion Robotic-Assisted Bronchoscopy Platforms: A Propensity Score-Matched Analysis

Lung cancer is the leading cause of cancer-related deaths. Earlier detection and diagnosis are crucial in improving overall survival. Limitations in conventional bronchoscopic biopsy techniques have prompted the development of robotic-assisted bronchoscopy (RAB) platforms. Among the RAB platforms, we report the first study comparing outcomes between the Ion and Monarch platforms.

In this single-center retrospective study, data were collected from adults (age>18 y) who underwent a RAB biopsy with the Monarch (11/23/21 to 3/10/23) or by the Ion (3/21/23 to 12/15/23). The primary outcome was diagnostic yield (DY). The secondary outcomes were robot procedure duration, radiation time, radiation dose, and complication rate. We performed propensity score-matched analysis.

A total of 365 patients (Monarch N=162, Ion N=203) were included in the analysis. DY for Ion and Monarch was 84.2% versus 71.0%, respectively (P=0.003). When compared with Monarch, Ion cases had a shorter robot procedure time [median (IQR): 37.00 (26.00, 51.00) vs. 70.00 (51.25, 87.00) min, P<0.001], shorter radiation time [median (IQR) 4.6 (3.00, 7.10) vs. 8.0 (5.80, 10.95) minutes, P<0.001], and lower radiation dose area product (DAP) [median (IQR): 22.70 (14.30, 38.35) vs. 40.00 (23.20, 67.80) Gy.cm2, P<0.001]. Pneumothorax rates were 1.0% versus 4.3% for Ion and Monarch, respectively (P=0.089).

This is a retrospective study that suggests that the Ion RAB system, when compared with the Monarch RAB system, had higher DY, shorter robot procedure time and radiation time, and lower radiation dose. A randomized controlled trial is needed to confirm or refute these findings.