Improved reachability during bronchoscopy with a novel multisection robotic bronchoscope

The incidence of pulmonary nodules (PNs) has increased as the result of expanded lung cancer screening. PNs are often difficult to access with conventional bronchoscopy. We report data from the first cadaveric assessment of a novel multisection robotic bronchoscope (snake robot, or SR) with follow-the-leader navigation.

This study was conducted in a human cadaver by 3 operators. The SR was compared against a conventional (OL-6.3) and thin bronchoscope (OL-4.2). Primary outcome was number of airway generations traversed from carina. Secondary outcomes included insertion depth, computed tomography-to-body divergence, and estimated volumes of lung parenchyma accessible for biopsy. Mann-Whitney U tests, paired t tests, and mixed regression models were used. Data are reported as n (%) or median (interquartile range).

The SR reached greater median airway generations (6 [5-8]) when compared with the OL-6.3 (4 [3-4]; P < .001) and OL-4.2 (5 [4-6]; P < .001); it outperformed the OL-6.3 in all lobes and reached significantly greater airway generations compared with the OL-4.2 in the right upper lobe (P = .045), right middle lobe (P = .009), and right lower lobe (P = .025). Median insertion depth for the SR was greater compared with the OL-6.3 (P < .001) and OL-4.2 (P = .002). This additional reach resulted in greater access to total (P = .009) and peri-bronchial lung volumes (P = .009), which could translate into accessibility of an additional 17,601 nodules/year in the United States.

The SR outperformed both the OL-6.3 and OL-4.2 with regard to reach within the tracheobronchial tree, resulting in significant additional lung parenchyma accessible for biopsy.