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Author Spotlight: Learning Systematic Bronchoscopy in a Simulation-Base Setting
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Learning Shape-Sensing Robotic-Assisted Bronchoscopy after Mastering Advanced Image-Guided Navigation Bronchoscopy.

Aniek R C Bruinen1, Roel L J Verhoeven1, Gerjon Hannink2

  • 1Department of Pulmonary Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.

Respiration; International Review of Thoracic Diseases
|January 8, 2026
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Summary
This summary is machine-generated.

Shape sensing robotic-assisted bronchoscopy (ssRAB) demonstrates proficiency using learning curve cumulative summation (LC-CUSUM) and cumulative summation (CUSUM) analyses for peripheral pulmonary lesion diagnosis. CUSUM indicated immediate control, while LC-CUSUM identified proficiency after approximately 42 procedures.

Keywords:
Diagnostic yieldLearning curveLearning curve cumulative summationLung cancerNavigation bronchoscopyPeripheral pulmonary lesionsShape-sensing robotic-assisted bronchoscopy

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Area of Science:

  • Pulmonology
  • Medical Robotics
  • Diagnostic Imaging

Background:

  • Shape sensing robotic-assisted bronchoscopy (ssRAB) is emerging for peripheral pulmonary lesion (PPL) diagnosis.
  • No studies have evaluated ssRAB learning curves using LC-CUSUM and CUSUM with diagnostic yield as the primary endpoint.

Purpose of the Study:

  • To assess the learning curve of ssRAB combined with CBCT using LC-CUSUM and CUSUM analyses.
  • To compare the efficacy of LC-CUSUM and CUSUM in evaluating procedural performance for PPL diagnosis.

Main Methods:

  • Single-center analysis of 131 ssRAB procedures with CBCT for PPL diagnosis.
  • Two experienced bronchoscopists utilized LC-CUSUM followed by CUSUM, and a separate CUSUM analysis.
  • Diagnostic yield was the strict endpoint for both methods.

Main Results:

  • LC-CUSUM analysis indicated proficiency after 43 (bronchoscopist 1) and 42 (bronchoscopist 2) procedures, with CUSUM confirming sustained performance.
  • Subsequent CUSUM analysis showed both bronchoscopists were in control throughout all procedures.
  • Median lesion size was 12mm (range 9-18mm).

Conclusions:

  • CBCT-enhanced ssRAB performance was in control from the start for experienced bronchoscopists.
  • LC-CUSUM and CUSUM are valuable tools for assessing learning curves and procedural performance in bronchoscopy.
  • LC-CUSUM assumes initial non-proficiency, requiring more procedures than CUSUM to establish statistical proficiency.