Image-guided shape-sensing robotic-assisted bronchoscopy for subaortic and paraaortic mediastinal lesion sampling

Area of Science:

• Pulmonology
• Interventional Bronchoscopy
• Thoracic Surgery

Background:

• Traditional mediastinal lymph node and lesion sampling (stations 5 and 6) requires invasive surgical procedures.
• Image-guided shape-sensing robotic-assisted bronchoscopy (ssRAB) offers potential for minimally invasive endoscopic access.
• The feasibility, diagnostic yield, and safety of ssRAB for challenging mediastinal sites were evaluated.

Purpose of the Study:

• To assess the feasibility, diagnostic yield, and safety of ssRAB for sampling subaortic (station 5) and paraaortic (station 6) mediastinal lymph nodes and lesions.
• To determine if ssRAB can serve as a less invasive alternative to surgery for mediastinal sampling.

Main Methods:

• Retrospective review of 16 ssRAB procedures targeting subaortic or paraaortic mediastinal lesions between October 2019 and September 2025.
• Data abstracted included patient demographics, imaging, procedural details, complications, and sampling outcomes.
• Primary endpoint: conservative diagnostic yield (rate of procedures establishing a specific diagnosis).

Main Results:

• A conservative diagnostic yield of 69% was achieved across 16 procedures.
• Lenient diagnostic yield was 73% after excluding one case.
• Specific conservative yields were 75% for subaortic and 62% for paraaortic sampling; one grade 1 pneumothorax occurred with no other complications.

Conclusions:

• Image-guided ssRAB is a feasible and safe minimally invasive technique for sampling mediastinal lymph nodes and lesions in challenging anatomical locations.
• ssRAB may provide an alternative to surgical sampling, reducing patient invasiveness.
• This retrospective series supports ssRAB as a valuable tool in the diagnostic armamentarium for mediastinal pathology.