Double-Lumen Intubation Facilitating a Single-Anesthesia Workflow in Robot-Assisted Navigational Bronchoscopy and...

Area of Science:

• Pulmonology
• Thoracic Surgery
• Medical Technology

Background:

• Robotic-assisted navigational bronchoscopy (RNB) with ION system and cone-beam computed tomography (CBCT) enables precise diagnosis of peripheral pulmonary nodules.
• Integrating RNB with intraoperative frozen section analysis can facilitate same-day resection, improving patient care.
• Standard airway management with single-lumen tubes (SLT) can delay transition to lung resection, while double-lumen tubes (DLT) may streamline workflow and enhance safety.

Purpose of the Study:

• To evaluate the diagnostic performance, procedural efficiency, and feasibility of an integrated ION-guided RNB workflow.
• To compare the outcomes of RNB using either SLT or DLT for airway management.
• To assess the potential of a streamlined 'one-stop-shop' approach for pulmonary nodule diagnosis and treatment.

Main Methods:

• A single-center retrospective study analyzing 36 consecutive patients undergoing ION-guided RNB for pulmonary nodules.
• Airway management (SLT vs. DLT) was determined by surgical planning.
• Lesions were targeted using CBCT or C-arm fluoroscopy, with biopsies performed via forceps or cryoprobes, followed by frozen section analysis to guide immediate resection.

Main Results:

• The study included 36 patients with 42 peripheral pulmonary nodules (mean diameter 1.22 cm).
• Overall diagnostic yield was 73.0%, significantly higher with DLT (84.2%) compared to SLT (50.0%) (p=0.035).
• DLT group also showed more biopsies per patient (7.9 vs. 3.2, p=0.035), with no major complications reported.

Conclusions:

• ION-guided RNB combined with CBCT and intraoperative frozen section allows accurate, single-session diagnosis and treatment of pulmonary nodules.
• Upfront DLT placement significantly enhances procedural efficiency and diagnostic yield within an integrated workflow.
• This 'one-stop-shop' approach streamlines care for pulmonary nodules without compromising diagnostic accuracy or safety.