Robotic-Assisted Bronchoscopy for Peripheral Pulmonary Lesions: Current Evidence, Clinical Applications, and Future Directions

The evaluation of peripheral pulmonary lesions (PPLs) is a persistent clinical challenge, made more pressing by the expansion of low-dose CT lung cancer screening. Conventional and earlier navigational bronchoscopy, including electromagnetic navigation, historically achieved diagnostic yields of approximately 60-70%, with CT-to-body divergence contributing to nondiagnostic sampling. This narrative review, prepared using the Scale for the Assessment of Narrative Review Articles (SANRA), summarizes robotic-assisted bronchoscopy (RAB) platform technology, procedural optimization, diagnostic performance, safety, molecular tissue adequacy, and emerging applications. A structured search was updated through September 2026; this is not a systematic review. Using the strict definition recommended by the American Thoracic Society/American College of Chest Physicians (ATS/ACCP), the most comprehensive meta-analysis reported a pooled RAB diagnostic yield of 69.6%, while the prospective multicenter TARGET study reported an adjudicated strict yield of 61.6%. Higher pooled estimates of approximately 84-87% generally use intermediate definitions that the ATS/ACCP statement recommends against as primary diagnostic-yield measures. RAB pneumothorax rates are approximately 2% in pooled analyses, compared with approximately 20-25% for CT-guided transthoracic needle biopsy. In the randomized RELIANT trial, RAB was non-inferior, but not superior, to electromagnetic navigation bronchoscopy; in VERITAS, navigational bronchoscopy as a category was non-inferior to transthoracic needle biopsy for 12-month diagnostic accuracy, with fewer pneumothoraces. RAB is a useful option for selected PPLs, but strict-definition performance is more modest than frequently quoted intermediate yields. Outcomes depend on lesion characteristics, sampling strategy, operator experience, center volume, and imaging infrastructure.