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Peer-reviewedCC BY-NC-NDJournal of thoracic disease

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

  • Shaohua Dai1,2
  • Wei Zuo3,4
  • Bentong Yu1,2
4 affiliations
  1. 1Department of Thoracic Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
  2. 2Department of Thoracic Surgery, Jiangxi Hospital of China-Japan Friendship Hospital, National Regional Center for Respiratory Medicine, Nanchang, China.
  3. 3Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
  4. 4Department of Respiratory and Critical Care Medicine, Jiangxi Hospital of China-Japan Friendship Hospital, National Regional Center for Respiratory Medicine, Nanchang, China.
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{dai2026evaluating,
  title = {{Evaluating robotic-assisted bronchoscopy for bronchus-unconnected peripheral pulmonary nodules: diagnostic efficacy and safety.}},
  author = {Shaohua Dai and Wei Zuo and Bentong Yu},
  journal = {Journal of thoracic disease},
  year = {2026},
  month = sep,
  doi = {10.21037/jtd-2026-2361},
  url = {https://europepmc.org/article/MED/42996979},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Evaluating robotic-assisted bronchoscopy for bronchus-unconnected peripheral pulmonary nodules: diagnostic efficacy and safety.
AU  - Shaohua Dai
AU  - Wei Zuo
AU  - Bentong Yu
PY  - 2026
DA  - 2026/09/30
JO  - Journal of thoracic disease
DO  - 10.21037/jtd-2026-2361
UR  - https://europepmc.org/article/MED/42996979
AB  - 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.
SN  - 2072-1439
SN  - 2077-6624
ER  -