Single anesthetic bronchoscopic biopsy to robotic resection workflow

Area of Science:

• Thoracic Surgery
• Pulmonology
• Medical Technology

Background:

• Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a novel technology for pulmonary nodule evaluation.
• ssRAB demonstrates safety and high diagnostic yield.
• Integration with robotic-assisted thoracic surgery enables a single-anesthesia approach for biopsy and resection.

Purpose of the Study:

• To describe a reproducible workflow for robotic bronchoscopy followed by pulmonary resection under a single anesthetic.
• To present a novel approach using a double-lumen endotracheal tube and lateral decubitus positioning.
• To detail the steps for room setup, airway management, bronchoscopic navigation, dye injection, and anatomic resection.

Main Methods:

• Utilized a double-lumen endotracheal tube and lateral decubitus positioning.
• Performed robotic bronchoscopy for diagnosis and dye marking.
• Transitioned to robotic-assisted thoracic surgery for anatomical resection.
• Provided step-by-step procedural details.

Main Results:

• The technique was successfully performed in all cases with minimal complications.
• Dye localization was accurate, aiding rapid lesion identification.
• ssRAB and dye marking added minimal operative time.
• Patients experienced uneventful postoperative recovery.

Conclusions:

• The streamlined technique is safe and efficient for diagnosing and treating early-stage lung cancer in one setting.
• Lateral positioning with a double-lumen tube enhances workflow efficiency.
• This approach can serve as a model for implementing single-anesthetic bronchoscopic resection pathways.