1,000 Robotic Navigational Bronchoscopies: Diagnostic Yield and Surgical Implications

A. R. Brownlee¹, W. Yu², C. Perez², L. Weiser², S. Soukiasian², J. Malas¹, H. J. Soukiasian^2
1Cedars-Sinai Medical Center, Los Angeles, California ²Cedars Sinai Medical Center, Los Angeles, California

Purpose: Evaluate a single institution experience using robotic navigational bronchoscopy for the diagnosis and management of pulmonary nodules and the rate that proceeded to surgical resection.

Methods: All patients who underwent robotic navigational bronchoscopy between September 2020 and May 2024. A procedure was defined as diagnostic if a benign or malignant result was obtained. A benign diagnosis required confirmation with repeat biopsy, resection, resolution or 1 year follow-up. Univariate and multivariate logistic regression models were used to determine factors associate with a positive diagnostic procedure. Subsequent surgical resection data was collected.

Results: One thousand nodules were biopsied during the study period. Mean procedure time was 68.0 mins  30.3 mins, mean nodule size 2.7cm  1.8cm. Overall diagnostic yield was 86.1% (n = 1000). The sensitivity and negative predictive value for malignant disease were 90.8% and 90.0% respectively, while the specificity and positive predictive value for benign disease was 89.4% and 91.7% respectively. In multivariate analysis, lung nodules  2.0cm were more likely to be diagnostic (OR, 2.46, 95% CI, 1.64-3.69, p < 0.0001). Nodule size decreased over time (Fig 1a), while procedure duration improved over time (Fig 1b). The pneumothorax rate was 3.1% with 1.6% requiring chest tube. A total of 20.4% (n = 204) of patients underwent a subsequent lobar or sublobar resection (124 lobectomies, 33 segmentectomies, 47 wedge). A total of 107 patients were consented for robotic bronchoscopy at the time of surgical resection during the same anesthetic event (for nodule marking (18), biopsy of primary nodule (78) or biopsy of a secondary nodule (11). Twelve of these cases were stopped at biopsy alone (5 benign nodules, 3 await final pathology, 3 nodal or lung metastasis, 1 lymphoma). All these results did not change on final pathology.

Conclusion: We report the largest series to date of robotic navigational bronchoscopy procedures with long term follow-up demonstrating excellent diagnostic yield and safety profile. In select cases, navigational bronchoscopy can effectively be combined with surgical resection.

Identify the source of the funding for this research project: none