Evaluating robotic-assisted bronchoscopy for bronchus-unconnected peripheral pulmonary nodules: diagnostic efficacy and safety

Bronchus-unconnected peripheral pulmonary lesions (PPLs) pose diagnostic challenges due to lack of direct airway access and computed tomography (CT)-to-body divergence (CTBD). We evaluated robotic-assisted bronchoscopy (RAB) combined with the intraprocedural CT-guided navigation with ventilatory strategy for atelectasis (ICNVA) strategy.

This prospective, single-arm study enrolled patients (18-75 years) with pulmonary nodules (6-30 mm) lacking a bronchus sign. All underwent RAB with the ICNVA strategy, integrating preoperative mapping, intraprocedural breath-holds to minimize atelectasis, and real-time CT confirmation. The primary endpoint was tool-in-lesion (TIL) rate. Secondary endpoints included diagnostic yield, center strike rate, CTBD, and safety.

Thirty patients were enrolled (mean age 55.6±10.7 years). Lesions had a mean diameter of 14.0±4.3 mm and a median distance to the nearest bronchus of 18 mm. The ICNVA strategy resulted in a mean CTBD of 13.4 mm. We achieved a 100% (30/30) navigational success rate (TIL) and a 66.7% (20/30) center strike rate. The overall diagnostic yield was 90% (27/30), with 90.9% (20/22) sensitivity for malignancy. Pneumothorax occurred in 2 patients (6.7%) and mild hemorrhage in 7 (23.3%), with no severe adverse events occurred.

RAB combined with the ICNVA strategy demonstrates high diagnostic yield and safety for bronchus-unconnected PPLs. This approach effectively mitigates CTBD, enabling precise localization and sampling of lesions traditionally considered difficult to access.