New technology to access deep recesses of the lungs now available locally

New robotic technology that uses a GPS-like system to map the outermost areas of the lungs is helping to fight cancer.

Robotic bronchoscopy, now available at Cape Cod Hospital, helps physicians see into areas of the lungs that have been previously out of reach, said interventional pulmonologist Michael Ayers, MD, FCCP. He and thoracic surgeon Jeffrey J. Spillane, MD, FACS, both perform the procedure, which uses digital mapping and robotic guidance, allowing doctors to divert from the main bronchial tubes into the smaller branches — like a car taking a turnoff from the interstate into a maze of backroads.

“If you looked at a mapping of the bronchial tree of anybody’s lungs, you’d be amazed at how many potential pathways – potential airways – there are throughout the lungs,” Dr. Ayers said. “And so, this is literally a GPS system [for] the lungs. … It allows us to pick a target and then form a pathway through the airways.”

Traditional bronchoscopes use a manually guided flexible tube about 5 to 6 millimeters in diameter (slightly smaller than a standard paper straw) with a light and camera at the end to see into the lungs. The tube can also be used as a tunnel for other probes to take tissue samples. Newer navigational bronchoscopy uses low-dose CT scans to map the patient’s lungs, creating a pathway to the suspicious area but the doctor still guides the catheter.

The Ion robotic bronchoscopy used at Cape Cod Hospital was developed by the medical company Intuitive. It uses a scope only 3.5 millimeters or so in diameter (about the diameter of a size 3 knitting needle) and relies on shape-sensing technology to measure its location, according to a 2024 Brazilian research survey of robotic technologies reported by the National Institutes for Health. It is able to reach the farthest edges of the bronchial system, near the pleura, or outer layer. It also relies on a CT scan to find the target and create a 3D route to it, but then works in real time, using remote-controlled robotics and fiber optics to navigate the pathway and guide the physician, who works from a video-game-like control stand.

“With this newer technology, we now have the ability to go after nodules that years ago we would never have gone after with bronchoscopy,” Dr. Ayers said. “It was a much-needed advanced form of bronchoscopy, and I think it is really a game changer in lung cancer diagnosis.”

Robotic bronchoscopy does not replace standard bronchoscopy but gives doctors another tool to reach the outer limits of the lungs, Dr. Ayers said. The 2024 report said that the Ion technology is one of two which, based on historical data, seem to be improving diagnoses.

Doctors Make a Plan

Patients are referred to a pulmonologist after a suspicious nodule shows up on a chest X-ray or CT (computed tomography) scan. If the nodule is large, doctors may investigate right away. If it is small, they might follow the patient for three to six months, then get a repeat CT scan, Dr. Ayers said. If the nodule enlarges, that’s a sign for further investigation, he said.

Doctors make a plan before the procedure, zeroing in on the target and using the robotic system to generate a 3-D bronchial map and a pathway. “But we also have the option to alter the pathway if we feel there’s a better way to get to it. Sometimes there are many different ways to get to a certain target,” Dr. Ayers said.

Besides biopsies, robotic bronchoscopy can be used for treatment and ablation of nodules, he said. “We’re very early in the stages of that, but it’s certainly the next step. So, not only are we going to be able to do a diagnosis, but we’re also going to potentially be able to do therapy of these very difficult peripheral nodules.”

How It’s Done

The robotic bronchoscopy takes 45 to 90 minutes. It is usually an outpatient procedure but done under general anesthesia, since it is done in the operating room of the hospital, he said. “Patients have to be out; they can’t be moving during this procedure,” he said.

Afterwards, patients spend an hour or two in the recovery room and then go home. They might experience a sore throat from the endotracheal tube inserted into their vocal cords during the procedure. They may also have a cough.

“Anytime you’re in the airway doing procedures, you’re going to cause irritation to that patient’s airways, and they’ll cough afterwards. It might last most of the day of the procedure, rarely will it last more than 48 hours,” Dr. Ayers said.

There might also be some bleeding in the airways, meaning patients might cough up some blood. There is a risk of collapsing a lung, but it is relatively rare, Dr. Ayers said – comparable to standard bronchoscopy at a 1 to 2 percent risk.

The vast majority of nodules turn out not to be cancer and could be caused by infections or other inflammation, Dr. Ayers said. But robotic bronchoscopy allows doctors to exclude cancer or find it sooner in the outer lungs.