Assessing the feasibility of shape-sensing robotic bronchoscopy mapping to lung nodules in pediatric patients

Pulmonary nodule localization is essential for many procedures in children with cancer. Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a preferred modality of nodule biopsy and localization in adult thoracic surgery, but its utility in pediatric surgery is unknown. We examined the feasibility of ssRAB including bronchial tree mapping and nodule localization in children.

We identified 14 pulmonary nodules in 11 patients aged 2-18 years on CT scans from 2021 to 2023. We created an additional 34 nodules in an expansion cohort from 17 patients aged 11-months to 17-years to increase sample size. Nodules were categorized as central or peripheral. Bronchoscopy routes were generated with target-to-lesion distance and airway diameter recorded. If the target-to-lesion was greater than 30 mm or airway diameter less than 3 mm, the pathway was manually adjusted. If after manual adjustment the parameters were not met then the pathway was unfeasible.

Of the 11 patients with the existing nodules, 66 % of peripheral nodules (8/12) and 100 % of central nodules (2/2) were feasibly mapped. When examining the feasibility of the expansion cohort 65 % of peripheral nodules (11/17) and 100 % of central nodules (17/17) were mapped. When comparing feasible and unfeasible nodules, there was no difference in patient age and tracheal diameter.

Given the success of our bronchial tree mapping and nodule identification, we conclude that ssRAB is a feasible approach to biopsy and pulmonary nodule localization in children. Peripheral location not age was detrimental to successful mapping. Trialing ssRAB for pediatric lung nodule localization is likely feasible.

Feasibility Study.

Level IV.