Sept. 07, 2023
Experts at Mayo Clinic found that combining mobile 3D imaging and shape-sensing robotic-assisted bronchoscopic biopsy of lung nodules was safe and overcame CT-to-body divergence in most patients. Combining the technologies allowed accurate visual placement of the biopsy tool in the lesion. In the pilot study, researchers safely achieved tool-in-lesion in 96.7% of cases. Results of the study were published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes in June 2022.
"We're moving toward a more accurate, efficient lung cancer diagnosis, improved techniques and a better outcome for lung cancer patients," says Janani S. Reisenauer, M.D., a thoracic surgeon and interventional pulmonologist at Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota. Dr. Reisenauer is also the chair of Thoracic Surgery and director of Mayo Clinic's Surgical Innovation Center.
Lung cancer is the leading cause of cancer-related death in people worldwide. Recent advancements in bronchoscopy techniques such as radial endobronchial ultrasound, electromagnetic navigation bronchoscopy, virtual bronchoscopic navigation and robotic-assisted bronchoscopy have improved diagnostic accuracy. These techniques, however, still present difficulties in precisely locating the lesion due to CT-to-body divergence.
CT-to-body divergence occurs because of the differences between a patient's lungs when they're mechanically ventilated during the bronchoscopy compared with the pre-procedural CT scans obtained from patients who are breathing naturally. Divergence can alter the virtual target, impacting both diagnostic accuracy and procedural outcome.
Overcoming CT-to-body divergence
In this study, researchers evaluated the clinical use of mobile 3D imaging in conjunction with shape-sensing robotic bronchoscopy to visualize and facilitate the biopsy of peripheral pulmonary nodules between 1 and 3 cm. Thirty lesions from 17 men and 13 women were biopsied.
Using 3D imaging feedback, researchers adjusted the shape-sensing robotic-assisted bronchoscopy to place their biopsy tool more accurately in the lesion. In this study, tool-in-lesion was successfully visualized at the time of the procedure in 29 lesions (96.7%).
"Being able to accurately locate the lesion is one of the biggest hurdles in diagnosis via bronchoscopy," says Dr. Reisenauer. "Having that mobile CT scan feeding us location information during the procedure, along with the shape-sensing technology, can improve bronchoscopy and, ultimately, a patient's outcome."
Biopsies resulted in twenty-two (73.3%) malignant nodules and six (20.0%) benign nodules, with no complications such as bleeding or pneumothorax. Diagnostic yield, 93%, was defined as a pathologic result that prompted a definitive treatment plan based on tumor board review.
Transforming the future of surgery to improve patient outcomes
The combination of shape-sensing robotic bronchoscopy and mobile CT imaging demonstrates promise in safely improving diagnostic yield while minimizing radiation exposure. Techniques that establish accurate diagnoses also enable the detection of specific genetic mutations in tumors, allowing for more-targeted treatment.
Mayo Clinic's Surgical Innovation Center is committed to revolutionizing patient care through inventive device development, exploring the boundaries of robotic surgery and optimizing procedures. Led by Dr. Reisenauer, the center uses a patient-centered approach to originate transformative technologies for surgery and improve patient care.
Dr. Reisenauer, the world's first dual fellowship-trained and board-certified interventional pulmonologist and thoracic surgeon, has a distinctive perspective on a patient's course of illness.
"Seeing the illness from both sides of the drapes unveils immense opportunities," says Dr. Reisenauer. "Having that dual certification empowers me to fuel innovation."
Revolutionizing lung cancer care with a single-procedure pathway
Adding mobile 3D imaging to shape-sensing robotic-assisted bronchoscopy enables researchers to precisely access previously unreachable lung nodules, enhancing diagnostic accuracy and facilitating targeted treatments.
This pilot study is a step forward in transforming lung cancer care. An accurate biopsy and diagnosis can lead to immediate lung cancer treatment. If malignant, the nodule can be removed within the same procedure, under the same anesthesia.
"I call this the 'single anesthetic lung surgery pathway,' and it means fewer trips to the hospital, less time away from family and shorter recovery times," says Dr. Reisenauer, who is currently involved in clinical trials that deliver cancer treatment within minutes of diagnosis.
Through ongoing research and innovative procedures, Dr. Reisenauer and her research colleagues are improving both patient experience and outcomes, making significant advancements in lung cancer care.
For more information
Reisenauer J, et al. Combining shape-sensing robotic bronchoscopy with mobile three-dimensional imaging to verify tool-in-lesion and overcome divergence: A pilot study. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2022;6:177.
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