An innovative robotic technology recently introduced at Scripps Memorial Hospital Encinitas holds significant promise for patients who need to have biopsy samples taken from lung nodules to diagnose a variety of respiratory issues, including lung cancer.
The goal of the new robotic bronchoscopy platform is to give patients an earlier, more accurate and less invasive approach to the diagnosis of lung diseases, compared to current conventional methods. Early diagnosis is particularly important in cases of lung cancer, as survival rates are generally far higher for patients diagnosed with early-stage disease, compared to disease confirmed in later stages.
“We view robotic bronchoscopy, in conjunction with intraoperative CT imaging, as a quantum leap forward for our ability to deliver early and less invasive diagnoses for our patients,” said Samir Makani, MD, director of interventional pulmonary medicine with Scripps Encinitas and a Scripps MD Anderson Cancer Center physician.
“It gives us two new and very important capabilities — first, the ability to reach into the most challenging parts of the lungs to get to nodules we couldn’t reach before. And second, to see the precise location of the nodule and our instruments throughout the entire procedure in real time.”
Bronchoscopy is a procedure in which a thin tube called a bronchoscope is inserted through the patient’s mouth, into the throat and trachea and into the airways of the lungs. The procedure is performed to explore a variety of respiratory issues, ranging from breathing problems to infections to lesions and nodules. It is frequently used to confirm or rule out lung cancer.
With robotic bronchoscopy at Scripps Encinitas, the physician remotely guides the scope into the patient’s lungs using a video game–style controller. With this device, doctors can use their fingers to control the scope with sub-millimeter accuracy as they direct it through twists and turns of the patient’s airways. For the first time, this gives physicians the ability to see and access the most challenging portions of the lung.
Scripps’ robotic bronchoscopy platform also offers a built-in navigation system that shows doctors the exact location of the scope and nodule in real time, throughout the procedure. The technology, which was recently cleared by the Food and Drug Administration, integrates the latest advancements in robotics, software, data science and endoscopy.
Scripps Encinitas combines the robotic system’s built-in visualization capability with its own intraoperative CT scanner, which provides extremely detailed 3D images of the patient’s nodule and scope during the procedure. This further improves the ability to take tissue samples from the exact desired spot.
Scripps Encinitas is the only hospital west of the Mississippi performing bronchoscopy with the combination of a robotic bronchoscopy system and a portable CT scanner. The hospital’s robotic bronchoscopy system, the MONARCH® Platform, is developed by Auris Health, and its BodyTom portable CT scanner is manufactured by NeuroLogica, a subsidiary of Samsung.
“Robotic bronchoscopy ... takes the doctor all the way to the nodule’s front doorstep with a higher degree of accuracy.”Scott Eisman, MD
With the current conventional approach to bronchoscopy, called navigational bronchoscopy, the physician advances the scope by hand into the patient’s lungs, which offers less control and stability than the robotic method. Also, doctors using navigational bronchoscopy are aided visually by a GPS-like system, which offers a virtual, computer-generated view of the scope’s location during the procedure. This provides an approximate reference point to help orient the physician, but it is not a precise view of the scope or nodule.
“Conventional navigational bronchoscopy can help the doctor get to the general neighborhood of the nodule, but robotic bronchoscopy, in conjunction with intraoperative CT imaging, takes the doctor all the way to the nodule’s front doorstep with a higher degree of accuracy,” said Scott Eisman, MD, physician chief operating executive at Scripps Encinitas. “Having the confidence of knowing we are taking the sample from the precise spot we want is absolutely critical to our ability to give patients the answers they need.”
Another conventional method of obtaining lung nodule samples involves inserting a needle from outside of the patient’s body, through the chest wall and into the lung. Although a good approach in the right situation, this approach also carries the risk of potential complications for patients, such as bleeding and lung collapse for lesions located deeper in the chest.
The minimally invasive robotic system used at Scripps Encinitas significantly reduces the need for an external needle biopsy in these more challenging locations, since it has been shown to thoroughly access all segments of the lungs.
Lung nodules — small masses of tissue in the lung — can result from inflammation, infection or scar tissue, and can be either benign or malignant. The only way to confirm if a nodule is cancerous is to obtain and examine a small piece of tissue.
According to the American Cancer Society, lung cancer is the leading cause of cancer death in the United States and early diagnosis is an important factor in patient outcomes. The five-year relative survival rate for patients diagnosed with lung cancer at an early, localized stage is 57%, compared to a 5% relative survival rate for lung cancer patients diagnosed at a later, distant stage.
Robotic bronchoscopy is available to patients as part of the Scripps MD Anderson partnership and through the Scripps Encinitas interventional pulmonary medicine program. It will also be part of the new Lusardi Pulmonary Institute being developed at the hospital. Scripps Encinitas acquired the robotic bronchoscopy system entirely through philanthropic gifts.
Learn more about Scripps Health, a nonprofit integrated health system in San Diego, Calif.