Assessing the Accuracy of a Multi-Section Robotic Bronchoscope Prototype in Localization & Targeting of Small Pulmonary Lesions

Objectives Robotic bronchoscopy (RB) has emerged as a novel technique to address issues with the biopsy of small peripheral lung lesions. The objective of this study was to quantitatively assess the accuracy of a novel multi-section robotic bronchoscope compared to current standards of care. Methods This is a prospective, single-blinded, comparative study where the accuracy of a multi-section RB was compared against the accuracy of standard electromagnetic navigational bronchoscopy (EM-NB) during lesion localization and targeting. Five blinded subjects of varying bronchoscopy experience were recruited to use both RB and EM-NB in a swine lung model. Accuracy of localization and targeting success was measured as the distance from the center of pulmonary targets at each anatomic location. Subjects used both RB and EM-NB to navigate to 4 pulmonary targets assigned using 1:1 block randomization. Differences in accuracy and time between navigation systems were assessed using Wilcoxon Rank Sum test. Results Of the 40 total attempts per modality, successful targeting was achieved on 90% and 85% of attempts utilizing RB and EM-NB, respectively. Furthermore, RB demonstrated significantly lower median distance to the real-time EM target (1.1 mm, IQR:0.6-2.0mm) compared to EM-NB (2.6mm, IQR:1.6-3.8) (p <0.001). Median target displacement resulting from lung and bronchus deformation during bronchoscopy was found to be significantly lower using RB (0.8mm, IQR:0.5-1.2mm) compared to EM-NB (2.6mm, IQR:1.4-6.4mm) (p<0.001). Conclusion The results of this study demonstrate that the multi-section RB prototype allows for improved localization and targeting of small peripheral lung nodules compared to current non-robot bronchoscopy modalities.