If you use a bronchoscope, your practice is about to change—dramatically. Robotic bronchoscopy is poised to transform lung cancer diagnosis and treatment, expanding the entire concept of interventional bronchoscopy.
“Robotic bronchoscopes are looked at by a lot of people as the next electromagnetic navigation system, letting us keep on doing what we have always done, just a little deeper into the lung,” said Michael J. Simoff, MD, FCCP. “I see the robot as a platform that will allow us to improve our diagnostic yield and let us enter the realm of direct treatment of lung cancer from within the lung.”
Dr. Simoff is Director of Interventional Pulmonology, Director of the Lung Cancer Screening Program, and Professor of Pulmonary and Critical Care Medicine at Wayne State University School of Medicine. He will deliver the 2021 Pasquale Ciaglia Memorial Lecture in Interventional Medicine, Robotic Bronchoscopy: Platform to the Future?, on Tuesday at 2:45 pm CT. Based on his own experience in robotic bronchoscopy as well as the expanding literature, the answer is yes.
Existing bronchoscopes are limited to the first four to six generations of airways. Electromagnetic navigation has allowed improved control and access to the periphery, but even the most experienced bronchoscopists rarely get a diagnostic yield greater than 70% or 75%.
The latest generation of robotic bronchoscopes can reach all segments of the lung while providing direct vision during navigation, adding the opportunity to better guide the approach to nodules. The operator can effectively anchor the bronchoscope at a specific location within the lung and make spatial adjustments of less than a millimeter for better targeting and more precise, more effective sample collection.
“Our preliminary local experience and data suggest that there has been a significant improvement in the diagnostic yield using robots,” Dr. Simoff said. “This is preliminary, as there is not a lot of good data yet. But the evidence is accumulating.
“When I say platform, I’m strongly suggesting that this is a tool that does not have a singular purpose,” he said. “The platform concept is broader than singular tools, but instead a function of how we move forward. If looked at with a broad vision, the blending of clinical management and more integrative lung cancer screening with the accurate and rapid diagnosis of smaller lesions will allow us to move into a much more aggressive set of approaches to diagnose and ultimately treat cancer.”
That starts, he added, with increasing the rate of early detection.
“The more cancers we can find and diagnose early, the more we can treat early, and ultimately, fewer people will die,” Dr. Simoff said. “If this is done broadly and systematically, soon we could reach a point where we will predominately only have early cancers, as we will have caught most of the more advanced.”
The potential to treat lung cancer from within is similarly exciting. Robotic platforms may be able to deliver chemotherapy and immunotherapy agents directly to lung tumors, minimizing systemic exposure and collateral damage compared with current delivery methods. The same platform should be able to deliver newer generations of injected therapies, he said, as well as directed energy using radiofrequency, microwave energy, or cryotherapy. Some of these tools are currently being used transthoracically, but endobronchial delivery should offer more precision with fewer risks using the robotic platform.
“I believe that this platform is the centerpiece of a programmatic approach to the obliteration of lung cancer,” Dr. Simoff said. “Robotic bronchoscopy expands the umbrella of interventional pulmonology.”
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