Simultaneous Use of Dual Bronchoscopes for Targeted Biopsy of Peripheral Lung Lesions: The Kissing Probe Technique

Background: Peripheral pulmonary lesions (PPLs) are increasingly detected due to widespread use of cross-sectional imaging and lung cancer screening. While cone-beam CT and robotic bronchoscopy have improved diagnostic accuracy, they remain resource-intensive and inaccessible in many settings. A novel technique employing simultaneous use of two bronchoscopes referred to as the "Kissing Probe Technique" was developed to provide real-time lesion localization and precise sampling using standard equipment. Methods: This retrospective, single-centre study included 43 patients with radiologically confirmed PPLs suspicious for malignancy. Under general anaesthesia with rigid bronchoscopy or continuous sedation with endotracheal intubation, two single-use bronchoscopes were introduced in parallel. The first (standard diameter) housed a radial EBUS probe for lesion localization, while the second (ultra-thin) guided a 1.1 mm cryoprobe to the lesion based on direct ultrasound and fluoroscopic confirmation. Cryobiopsies were performed once "kissing contact" between the radial probe and cryoprobe was established. Results: A total of 43 procedures were completed without major complications. The mean lesion size was 24.6 mm. Radial probe localization was successful in 86% of cases, and tool-contact confirmation was achieved in 35/43 patients (81%). The overall diagnostic yield was 83.7% (36/43). Bleeding occurred in 23% of cases and was managed conservatively without the need for escalation of care. No pneumothorax or equipment-related damage occurred. Conclusions: The "Kissing Probe Technique" is a safe and feasible approach for bronchoscopic sampling of PPLs. It offers a cost-effective alternative for real-time tool-in-lesion confirmation using widely available equipment. Further multicentre validation is warranted to confirm generalizability and cost-effectiveness.