Best practices in shape-sensing robotic bronchoscopy with mobile cone beam computed tomography guidance: how I do it

Recent studies have demonstrated that shape-sensing robotic bronchoscopy with mobile cone-beam computed tomography (CBCT) guidance results in superb diagnostic outcomes for the diagnosis of peripheral lung lesions. Given the more favorable safety profile and the ability to also stage the mediastinum with endobronchial ultrasound when indicated, the combination of these technologies is likely to replace percutaneous computed tomography (CT)-guided biopsies of peripheral lung nodules in the years to come. Hands-on training in simulators, mannequins or cadaveric models is paramount before adopting this technique, but certain procedural and pre-procedural steps can only be practiced during true cases. Just like with any other new technology, there is an expected learning curve that physicians will go through before obtaining the desired procedural outcomes. Through the current manuscript we share some guidance based on years of research and clinical experience, which we hope will shorten the learning curve for newly adopters of these technologies. We have incorporated into our practice a systematic approach that maximizes the efficiency of patient positioning, integration of mobile CBCT and shape-sensing robotic bronchoscopy, as well as prevention of atelectasis and target motion. We believe this approach is key to maximizing efficiency and procedural outcomes, and we are honored to share it with the readers.