Shape-Sensing Robotic Bronchoscopy With Simultaneous Biopsy of Multiple Ipsilateral and Bilateral Pulmonary Nodules

Robotic bronchoscopy with shape-sensing technology enables simultaneous biopsy of multiple pulmonary nodules, including both ipsilateral and bilateral nodules. While this technique holds promise, there is evolving data on its diagnostic yield and complication rates, especially in patients undergoing multiple ipsilateral and bilateral pulmonary nodules biopsies.

The primary endpoint was to compare the diagnostic yield and complication rate of multiple pulmonary nodule biopsies (MPNBs) to that of a single pulmonary nodule biopsy. The secondary endpoint was to compare the diagnostic yield and complication rate of multiple ipsilateral biopsies to that of multiple bilateral biopsies. This single-center, IRB-approved retrospective study examined 526 patients who underwent robotic-assisted bronchoscopy with a shape-sensing platform at our center between June 2021 and December 2023.

Of the 526 included patients, 376 (71.5%) underwent single pulmonary nodule biopsy and 150 (28.5%) underwent MPNB. The only demographic difference was elevated Cocci serology or history (12.8%) in the single-nodule biopsy group. A similar diagnostic yield of 88% was seen in both groups. Within the MPNB group, 82 had multiple bilateral nodules, and 68 had biopsy of multiple ipsilateral nodules. A total of 339 pulmonary nodules were biopsied in the 150 MPNB patients. The size and location distribution of biopsied nodules were similar between ipsilateral and bilateral MPNB procedures. The radial ultrasound signal after robotic navigation was concentric, eccentric, or absent in 41.7%, 35.6%, and 22.7% of nodules, respectively. Intraoperative CT was used in 56% of MPNB procedures. The diagnostic yield of MPNB using Delphi criteria was 88% (58.7% malignant, 29.3% benign, and 12.0% nondiagnostic). Bleeding occurred in 3.3% of cases and pneumothorax in 6.0% (7 of 9 required chest tube placement). The hospitalization rate due to complications and comorbidities was 8.0%. Complication and hospitalization rates between multiple ipsilateral and multiple bilateral biopsies were similar.

This study demonstrates a higher rate of pneumothorax requiring chest tube placement and hospitalization after multiple ipsilateral or bilateral pulmonary nodule biopsies compared with a single pulmonary nodule biopsy with a shape-sensing robotic bronchoscopy platform.