Comparing Complications Between Shape-Sensing Robotic-Assisted Bronchoscopy and Trans-Thoracic Needle Pulmonary...

Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a navigation platform for biopsy of indeterminate pulmonary lesions. Large-scale, real-world evidence confirming the safety profile of ssRAB compared to transthoracic needle biopsy (TTNB) is needed.

A retrospective cohort study was performed using the PINC AI healthcare database among patients who underwent ssRAB or TTNB lung lesion biopsy at participating hospitals between April 2019 and March 2023. Outcomes were rates of pneumothorax and pneumothorax requiring chest-tube intervention within 3 days, and rates of in-hospital bleeding or all-cause death. Quasi-binomial logistic regression analysis was performed after one-to-five propensity score matching (PSM) accounting for patient- and hospital-related characteristics.

A total of 119 424 patients (5121 ssRAB, 114 303 TTNB) were identified with 4554 ssRAB and 14 319 TTNB patients after PSM. Relative to ssRAB, TTNB had significantly higher risk of pneumothorax (18.4% vs. 2.6%, OR = 7.10, p < 0.001) and pneumothorax requiring chest-tube (10.8% vs. 1.4%, OR = 7.62, p < 0.001). TTNB was associated with a higher risk for bleeding (1.5% vs. 0.6%, OR = 2.20, p < 0.001) and all-cause death (0.48% vs. 0.15%, OR = 2.47, p = 0.023); however, rates for both outcomes were relatively low.

In this large-scale, real-world database analysis with diverse patient populations, physician experience, and health care settings, ssRAB demonstrated a better safety profile compared to TTNB. Superior safety combined with a potentially comparable performance profile and known advantages of bronchoscopy, including concurrent staging, support ssRAB as an optimal choice for non-surgical biopsies for suspicious pulmonary lesions.