Robotic Bronchoscopy Now Available for Patients in North Central Pa.

UPMC experts in north central Pa. now have a new tool to use in the battle against lung cancer – with the introduction of the Ion^® by Intuitive robotic bronchoscopy system at UPMC Williamsport.

“We are thrilled to be able to provide this novel technology for our patients in the community,” says Ganga Ranasuriya, MD, a pulmonologist at the hospital. “We are hopeful that the Ion robotic bronchoscopy will enable us to biopsy lung nodules that are deep within the lung, in a safe and effective manner.”

“I think the main benefit of the Ion is that it is highly accurate, precise, and it can detect lung cancer in its earliest, most treatable stages,” adds Syed Yazdani, MD, a cardiothoracic surgeon at the UPMC Heart and Vascular Institute at UPMC Williamsport. “Early detection of lung cancer is the most important predictive factor to long-term survival.”

At the beginning of a robotic bronchoscopy procedure, a CT scan is performed, and the data obtained are used to generate a 3D rendering of the patient’s lungs. The robotic bronchoscopy software uses this rendering to evaluate routes through the respiratory tree to reach each lung nodule. The physician evaluates the reconstruction and the recommendations given by the software and determines if biopsy with robotic bronchoscopy is likely to be successful.

With the patient under general anesthesia, the physician begins the endoluminal robotic bronchoscopy and navigates down the trachea, into either mainstem bronchus, and through increasingly smaller bronchi and bronchioles using the 3D reconstructed image of the lungs and the camera on the bronchoscope.

When the physician reaches the destination, a lung nodule with an endoluminal component will often be evident. If the lesion is small or outside of the airway, the physician can rely solely on the location information provided by CT imaging and might also insert a radial ultrasound probe through the working channel to obtain more information about the nodule. The ultrasound has been found to be particularly useful for nodules less than 1 cm in diameter. The physician can then lock the bronchoscope into position, where it stays stable as tools for biopsy, such as endoscopic needles or forceps, are inserted.

The ability to maintain visualization of the airway while navigating to a nodule is a big improvement over previous electromagnetic navigational bronchoscopy (ENB) systems. Similarly, the ability to guide the bronchoscope to the periphery of the lung without manipulations that require doctors to contort their hands, arms, or body and then lock it into a stable position is a game-changing advance in the technology. The catheter can be positioned as needed and will stay in position.

“The stability of this catheter enables us to obtain more precise biopsies and lung tissue samples with decreased complications like pneumothorax (collapsed lung) when compared to traditional biopsy methods” explains Dr. Ranasuriya.

The Ion platform is easy to use as a teaching tool. The primary physician can see the same field as the trainee, give verbal guidance, and assume control of the bronchoscope, if necessary, without the risk of inadvertently repositioning it.

In addition to UPMC Williamsport, robotic bronchoscopy is also offered at UPMC Hamot in Erie, UPMC Hanover, UPMC Mercy and UPMC Passavant in Pittsburgh, and UPMC West Short in Mechanicsburg.