Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center.
Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center;
J Vis Exp. 2024 Jul 19(209). doi: 10.3791/66868.
Robotic-assisted bronchoscopy (RAB) allows for targeted bronchoscopic biopsy in the lung. A robotic-assisted bronchoscope is navigated through the airways under direct vision after establishing a pathway to a target lesion based on mapping performed on a 3-dimensional (3D) lung and airway reconstruction obtained from a pre-procedure thin-slice computed tomography chest. RAB has maneuverability to distal airways throughout the lung, precise catheter tip articulation, and stability with the robotic arm. Adjunct imaging tools such as fluoroscopy, radial endobronchial ultrasound (r-EBUS), and cone beam computed tomography (CBCT) can be used with RAB. Studies using shape-sensing robotic-assisted bronchoscopy (ssRAB) have shown favorable diagnostic outcomes and safety profiles in both malignant and non-malignant processes for the biopsy of peripheral pulmonary lesions (PPLs). A 1.1 mm cryoprobe combined with ssRAB has been shown to be safe and effective for the diagnosis of PPLs compared to a traditional bronchoscopy with forceps biopsy. This technique can also be used for targeted lung sampling in benign processes. The aim of this article is to describe a stepwise approach to performing RAB combined with fluoroscopy, r-EBUS, and CBCT to obtain targeted transbronchial lung cryobiopsies (TBLC).
机器人辅助支气管镜检查（RAB）可实现肺部靶向支气管镜活检。在根据术前薄层 CT 胸部扫描获得的三维（3D）肺部和气道重建进行的定位后，在直视下将机器人辅助支气管镜通过气道引导至目标病变部位。RAB 具有在整个肺部到达远端气道的可操作性、精确的导管尖端关节运动以及机器人臂的稳定性。可以使用附加的成像工具，如透视、径向支气管内超声（r-EBUS）和锥形束 CT（CBCT）与 RAB 一起使用。使用形状感应机器人辅助支气管镜检查（ssRAB）的研究表明，在恶性和非恶性病变中，对周围性肺病变（PPL）进行活检时，该检查具有良好的诊断效果和安全性。与传统的活检钳支气管镜检查相比，将 1.1 毫米冷冻探针与 ssRAB 联合使用可安全有效地诊断 PPL。该技术也可用于良性病变的靶向肺采样。本文的目的是描述一种分步方法，用于进行 RAB 联合透视、r-EBUS 和 CBCT 以获得靶向经支气管肺冷冻活检（TBLC）。
