What is the key question?

• The ACQUIRE registry analysis supported the concept that navigational bronchoscopy performed in real word settings is less accurate than reported in device trials in expert hands.
• Two robotic bronchoscopy systems have been developed.
• This single institution feasibility study investigates the incidence of serious adverse events (SAE) and technical feasibility of the Auris Robotic Endoscopy System (RES).

What is the bottom line?

• 15 patients who met inclusion criteria including a positive bronchus sign had preplanning of images and robotic bronchoscopy under GA in operating room though a size 8 endotracheal tube. Mono-planar fluoroscopy and pre-planned CT pathway was used to guide procedure without electromagnetic navigation or radial probe EBUS.
• Samples were taken using 24.5 G needles and 4.1 mm cup biopsy forceps. ROSE was available for all cases.
• Post procedure chest x-ray was performed on all.
• No SAE occurred.
• One procedure failure occurred.
• Lesion size was 2.6 cm average (1-6.3 cms).
• Direct visualisation of deployment of biopsy forceps was feasible in all with aid of integrated irrigation feature.
• Cancer was identified in 9 patients and benign features in 5/6 patients (necrotizing pneumonia, Loeffler syndrome, actinomycosis, surgical scar, and atypical mycobacteria.)
• One patient required a surgical biopsy to confirm cancer diagnosis.

Why read on?

• Technical advances included with robotic bronchoscopy platforms including robotic equipment, imaging techniques and processing and consumables are potentially ground breaking but come with a significant cost.
• The authors contribute low SAE rate in comparison to transthoracic needle biopsy to robotic equipment and stability of movement and control and training pre-procedure.
• The authors state it is their opinion that robotic bronchoscopy will reach lesions beyond the reach of conventional bronchoscopy however this needs to be evaluated in a prospective study.