Efficacy Of Single Anesthesia Bronchoscopy And Resection Utilizing The Shape Sensing Robotic Navigational Platform
Bhupaul Ramsuchit, Nicholas MacDonald, Matthew Johnston, Juan Escalon, Luis Herrera.
Orlando Health, Orlando, FL, USA.
BACKGROUND: Robotic navigational bronchoscopy has augmented diagnostic yield and localization of challenging pulmonary nodules. However, there is a paucity of literature regarding its role in decision making during single anesthesia bronchoscopy and resection (SABAR). We aim to describe our experience of SABAR via shape sensing robotic navigational bronchoscopy (SSRNB).
METHODS: A retrospective observational study was performed of adult patients who underwent SSRNB between August 2020 and April 2022. Diagnostic yield, localization success, treatment timelines, and cost were analyzed. Patients were classified on preoperative intent of SABAR for either localization or diagnostic yield. Localization was intended in nonpalpable peripheral nodules and multifocal nodules, whereas diagnostic yield was intended in deep nodules and multifocal nodules. However, additional samples were taken and localization performed of several lesions outside of the intended role and are included.
RESULTS: A total of 73 patients and 96 nodules were analyzed. Average age was 67 with 43/73 (59%) being female. Approximately 58/73 (80%) of patients identified as current or former smokers and 12/73 (16.4%) had a prior history of lung cancer. The average tumor size was 1.4 cm. Localization confirmed by fluorescence imaging was achieved in 56/56 (100%) patients with localization intent and 76/76 (100%) of the entire sample. Successful diagnostic yield was obtained in 20/26 (76.9%) patients with biopsy intent who then underwent immediate resection. Diagnostic yield for the entire sample was 47/76 (61.8%). Eight of fourteen benign nodules identified by SSRNB were resected due to persistent concern and confirmed to be benign. The remainder were noted to be in patients with multifocal lesions and only the primary diseased nodule was resected. Surgical resection occurred within 30 days of initial consultation for 50/73 (70%) patients. A total variable cost saving of $4,000 was observed in SABAR relative to separate procedures.
CONCLUSIONS: This novel study demonstrates that SABAR with SSRNB is an effective way to intra-operatively localize and potentially diagnose difficult lung nodules during planned resection. This efficacy accelerates treatment timelines and decreases hospital cost. Future studies are warranted to delineate the most reliable sampling tool and patient populations who would benefit most from SABAR using SSRNB. 
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