Robotic-assisted bronchoscopy in the diagnosis of peripheral pulmonary lesions

More peripheral pulmonary lesions(PPLs)are detected by low-dose helical computed tomography(CT)either in-cidentally or via dedicated lung cancer screening programs.Thus,using methods for safe and accurate diagnosis of these lesions has become increasingly important.Transthoracic needle aspiration(TTNA)and transbronchial lung biopsy(TBLB)are routinely performed during the diagnostic workup for PPLs.However,TTNA often car-ries the risk of pneumothorax,uncontrollable airway hemorrhage,and does not allow mediastinal staging in one procedure.In contrast,traditional TBLB often has a poorer diagnostic yield despite fewer complications.With the ongoing development of technology applied to bronchoscopy,guided bronchoscopy has become widely used and the diagnostic yield of TBLB has improved.Additionally,guided bronchoscopy continues to demonstrate a better safety profile than TTNA.In recent years,robotic-assisted bronchoscopy(RAB)has been introduced and imple-mented in the diagnosis of PPLs.At present,RAB has two platforms that are commercially available:Monarch TM and Ion TM;several other platforms are under development.Both systems differ in characteristics,advantages,and limitations and offer features not seen in previous guided bronchoscopy.Several studies,including cadaveric model studies and clinical trials,have been conducted to examine the feasibility and performance of RAB using these two systems;large multicenter studies are underway.In this review,published experimental results,focus-ing on diagnostic yield and complications of RAB,are analyzed and the potential clinical application of RAB is discussed,which will enable the operators to have a clear overview of RAB.

Bronchoscopic management of persistent air leaks

Air leaks can occur as a complication of thoracic surgery,bronchoscopic procedures,or from barotrauma due to mechanical ventilation.Persistent air leaks defined as air leaks that last longer than 5–7 days are often associated with prolonged hospital stay,higher rates of intensive care unit admission,and a significant source of morbidity and mortality.Surgical repair of persistent air leaks via thoracotomy or videoassisted thorascopic surgery generally has excellent success.However,for patients with severe hypoxemia,poor functional status,or significant comorbidities,surgical repair may not be feasible.The use of bronchoscopic interventions such as the delivery of coils,covered airway stents,endobronchial valves,biological sealants,and other devices to safely and effectively manage persistent air leaks has been widely reported in recent years.Bronchoscopic intervention of persistent air leak has a reported success rate of closure ranging from 30–80%depending on the underlying disease,location,and size of the pleural fistula.It is an excellent option for patients with persistent air leak who are critically ill and are poor surgical candidates.Advantages of using endobronchial devices include quick recovery time,relatively low risk,reduction in hospital stay,and the potential for immediate symptom relief.Here,we review the data regarding the use of bronchoscopic techniques in the management of persistent air leak.