From the Guidelines
Robotic lung biopsy using ION guided navigation is a minimally invasive procedure that combines robotic technology with a specialized navigation system to access small, hard-to-reach lung lesions, utilizing a thin, flexible catheter and shape-sensing technology to collect tissue samples under moderate sedation. This technique is an advancement in diagnosing lung nodules, offering several advantages over traditional methods, including higher diagnostic yield for small nodules and reduced complications compared to transthoracic needle biopsies 1. The procedure consists of several key components, including:
- A thin, flexible catheter equipped with shape-sensing technology inserted through the patient's mouth and navigated through the airways into the lungs
- The ION platform uses CT scan images to create a 3D map of the patient's lungs, allowing the physician to plan the optimal path to the target nodule
- The robotic system guides the catheter precisely to the target location using this map, even reaching peripheral nodules that traditional bronchoscopy cannot access
- Tiny biopsy tools are passed through the catheter to collect tissue samples for pathological examination The entire procedure is performed under moderate sedation rather than general anesthesia and typically takes 30-60 minutes to complete, offering shorter recovery times and the ability to reach lesions in difficult locations 1. Key benefits of this approach include:
- Higher diagnostic yield for small nodules
- Reduced complications compared to transthoracic needle biopsies
- Shorter recovery times
- Ability to reach lesions in difficult locations
- Real-time feedback on the catheter's position, enhancing precision and safety during the procedure Overall, robotic lung biopsy using ION guided navigation is a valuable tool in the diagnosis of lung nodules, providing a minimally invasive and effective alternative to traditional methods 1.
From the Research
Robotic Lung Biopsy Using Ion Guided Navigation
- The Ion Endoluminal Platform (ION) is a minimally invasive robotic-assisted bronchoscopy platform that has been US Food and Drug Administration approved for the performance of fine needle aspirations (FNAs) and biopsies of peripheral lung lesions 2.
- The platform uses rapid on-site intraoperative diagnosis (IOD) of FNAs and/or frozen section of biopsies to help surgeons confirm adequate sampling of the targeted lesion and allow definitive treatment in selected cases 2.
- The IOD rendered during adequacy assessment were compared with final cytology diagnoses (Cyto-FD) and the ultimate final diagnoses (U-FD), showing a concordance of 62% and a sensitivity of 67% and a specificity of 99% for malignancy 2.
Computed-Tomography-Guided Lung Biopsy
- Computed tomography (CT)-guided lung biopsy is a minimally invasive percutaneous procedure that requires knowledge of principles and techniques to perform safely and effectively 3.
- The procedure involves the use of CT guidance to insert a needle into the lung lesion, and the choice of needle size and type, as well as patient positioning, can affect the risk of complications such as pneumothorax 3, 4.
- The use of general anesthesia with apnoea has been shown to be a safe and feasible alternative to conventional CT-guided lung biopsy under local anesthesia for technically challenging lesions 5.
Risk Factors for Pneumothorax
- Pneumothorax is a common complication of CT-guided lung biopsy, with a pooled incidence of 25.9% and chest drain insertion of 6.9% 4.
- Risk factors for pneumothorax include patient positioning, with the lateral decubitus position where the biopsied lung is dependent being associated with a reduced risk of pneumothorax 4.
- Other risk factors include larger calibre guide/needles, fissure crossed, bulla crossed, multiple pleural punctures, multiple non-coaxial tissue samples, emphysematous lungs, smaller lesions, lesions without pleural contact, and deeper lesions 4.