Robotic-Assisted Bronchoscopy for Peripheral Pulmonary Lesions: Current Evidence, Clinical Applications, and Future Directions.
- 1Interventional Pulmonology and Cystic Fibrosis Program, Sanford Health, Fargo, ND 58102, USA.
- 2Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58203, USA.
Abstract
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.
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BibTeX
@article{kanchustambham2026roboticassisted,
title = {{Robotic-Assisted Bronchoscopy for Peripheral Pulmonary Lesions: Current Evidence, Clinical Applications, and Future Directions.}},
author = {Venkatkiran Kanchustambham},
journal = {Diagnostics (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/diagnostics16193151},
url = {https://europepmc.org/article/MED/42882306},
note = {CC BY},
}
RIS
TY - JOUR
TI - Robotic-Assisted Bronchoscopy for Peripheral Pulmonary Lesions: Current Evidence, Clinical Applications, and Future Directions.
AU - Venkatkiran Kanchustambham
PY - 2026
DA - 2026/09/28
JO - Diagnostics (Basel, Switzerland)
DO - 10.3390/diagnostics16193151
UR - https://europepmc.org/article/MED/42882306
AB - 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.
SN - 2075-4418
ER -