Apneic oxygenation during robotic-assisted bronchoscopy: a retrospective study on safety and diagnostic yield

Robotic-assisted bronchoscopy (RAB) with advanced imaging is an established technique for the biopsy of peripheral pulmonary lesions (PPLs). Anesthesia protocols are used to minimize respiratory motion and atelectasis. Apneic oxygenation, which maintains oxygenation during apnea without active ventilation, is used in short durations during image acquisition or biopsy. There is limited data available regarding the use of prolonged apneic oxygenation during RAB biopsy procedures. The primary objective was to assess safety and diagnostic outcomes using this technique.

This is a retrospective study of patients undergoing RAB with mobile cone beam computed tomography (mCBCT) for the biopsy of PPLs at a single center between September and December 2023 using an anesthesia protocol with prolonged apneic oxygenation. Patient demographics, procedural details, adverse events, and diagnostic outcomes were collected and analyzed.

A total of 108 procedures were performed to biopsy 136 PPLs, with a median lesion size of 15 mm. Apneic oxygenation was used for a median of 23 minutes per procedure, during which the median end-tidal carbon dioxide (ETCO₂) level increased from 23 to 59 mmHg. Vasopressors were required in 65% of patients, with no lasting hemodynamic effects. Immediate adverse events occurred in 4.6% of cases, all bleeding related (1.9% were grade 4); no pneumothorax was observed. The strict diagnostic yield at index RAB was 88%.

This is the first study to describe prolonged apneic oxygenation in RAB for PPL biopsy. The findings suggest that this technique may be a safe diagnostic approach in selected patients. Procedures should be performed at centers with expertise in advanced bronchoscopy and peri-procedural management.