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  • Diagnostic performance of shape-sensing robotic-assisted bronchoscopy for pleural-based and fissure-based pulmonary lesions

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Lung cancer
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Diagnostic performance of shape-sensing robotic-assisted bronchoscopy for pleural-based and fissure-based pulmonary lesions
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  • Published on: 16 April 2025
    Navigating obstacles to robot assisted bronchoscopy: Lessons from the global uptake of endobronchial ultrasound guided transbronchial needle aspiration.
    • Marcus Kennedy, Professor of Respiratory Medicine, Interventional Pulmonologist Cork University Hospital, Republic of Ireland

    To the Editor,

    The authors of both the original article and accompanying editorial endorse the diagnosis of lung nodules with shape sensing robotic assisted bronchoscopy (ssRAB) (1,2). Whether or not you agree with the conclusion from this single centre retrospective single arm study that ssRAB has high sensitivity (without a rigid gold standard) and a better safety profile than CT guided biopsy (the data presented does not include the fact that most CT guided biopsy related haemorrhage and pneumothorax are treated conservatively (3)), cost is not discussed. Upfront capital investment is significant, however in a health care setting where “money follows the patient”, it may be offset by downstream revenues. However ssRAB currently necessitates access to general anaesthesia, not only due to the length of procedure and diameter of the equipment but also any guided bronchoscopy modality without assisted ventilation is hampered by parenchymal atelectasis which creates error between preloaded CT imaging and device position (4). Although the prevalence of global access to general anaesthesia (whether in an operating room or endoscopy unit) is unknown, access in nationalised healthcare settings and healthcare in poorer countries already is inadequate as reflected by surgical wait times (5). Cost is not once discussed in the study presented (1) and even in the editorial (2), the only cost consideration discussed is in relation to the price of clinical trials.
    Lesson...

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    Conflict of Interest:
    None declared.