Robotic-Assisted Bronchoscopy

What Is Robotic-assisted Bronchoscopy?

Bronchoscopy is a technique used to look at your air passages with a small camera that is located at the end of a flexible tube. The camera connects to a video screen where your doctor can view photos of your air passages. The tube also has a small channel to collect tissue samples (a biopsy) from your lung that can be used for disease diagnosis.

Bronchoscopy technology has advanced with the development of robotic-assisted bronchoscopy (also known as robotic bronchoscopy). This technology allows physicians to move the flexible bronchoscopy tube with precision using a controller. The tube used in robotic bronchoscopy is typically smaller than those that may be used in traditional bronchoscopy. The physician uses the controller to move the small tube in precise ways which allows the physician to reach parts of the lung that may have been challenging to access with traditional bronchoscopy techniques. While the physician is controlling the robotic system, a 3-D map of the patient’s lung is shown on a computer screen. This allows the physician to see exactly where the tube is in the person’s lung and where it needs to go, and guides the physician to get to the nodule, much like GPS in a car.

Who is eligible?

Robotic-assisted bronchoscopy (RAB) is performed in eligible patients who are diagnosed with lung nodule or lung mass that needs biopsy to find out if it is cancerous or not. Robotic bronchoscopy also helps physicians get the samples they need which may help to determine if the nodule is cancerous, the type of lung cancer and if there are biomarkers.

How to Prepare

You will not be able to eat or drink anything after midnight the night before the RAB. However, your doctor may allow you to take some of your medications. Please be sure to ask your physician how to handle your daily medications prior to the procedure.

The sedative medicine used can remain in your body for several hours after the procedure is over. You may need someone to take you home, since you will not be allowed to drive after being discharged.

What to Expect

The doctor will explain the procedure and potential risks before getting your signed consent. This is the time to ask any specific questions that you may have.

A nurse will go over your medical history and medication use. An intravenous line (IV) will be to deliver any medicines during the procedure. Monitors will be placed to continually check your blood pressure, heart rate and oxygen level during the procedure. An oxygen mask or nasal tubing will also be placed to provide you with additional oxygen.

You will be given sedative medicines and potentially numbing gels or sprays prior to the procedure.

After you are sedated, a flexible, tube (catheter) is inserted through your endotracheal tube. The catheter is then steered by a controller operated by the physician. Imaging allows the physician to see exactly where they are in your body at all times. The physician steers the catheter in a designated path that is pre-mapped from a CT scan of your lungs, leading directly to the target nodule.

Once the physician has arrived at the target nodule, the physician confirms the location, the camera is removed and biopsy tools, like biopsy needle, are used to take tissue samples from the nodule. Robotic-assisted bronchoscopy allows the physician to precisely place the biopsy needle into different areas of the nodule in real time. Often, a pathologist is on site to look at the tissue under the microscope during the procedure and provide feedback on whether enough tissue was sampled. Sometimes, the pathologist on site can also test whether the tissue is cancerous or not. If more tissue samples are needed, the physician can biopsy the same nodule again by changing where they get the sample from in the nodule.

You will likely be able to go home the same day as your procedure.

Understanding the Results

After the procedure, your doctor may discuss the findings of the bronchoscopy and future healthcare plans with you. However, because of the effect of the sedation medications, you may not remember all the details. It is always recommended to have the doctor speak to your family member or healthcare advocate regarding results and any treatment plan.

What are the Risks?

Your blood oxygen level may become low during the procedure because of sedation or the scope being in your air passages. The team will give you extra oxygen during the procedure. Because the bronchoscope is inserted through your vocal cords, you may have a cough during and after the procedure. A sore throat after the procedure is common and cough drops may help.

Other risks may include infection, spasming of the airways, a hole in the airway or a collapsed lung. Your doctor will speak with you about the risks and benefits of robotic bronchoscopy. In general, the robotic-assisted bronchoscopy technology has made it possible for physicians to use small, nimble tools and visualization to biopsy your lung.