Kacey William J, Liesman Daniel R, Dodd Ashley C, Papastefan Steven T, Lung Kalvin C, Goldstein Seth D, Lautz Timothy B
Department of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Pediatr Surg. 2025 Aug 8:162519. doi: 10.1016/j.jpedsurg.2025.162519.
Pulmonary nodule localization is essential for many procedures in children with cancer. Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a preferred modality of nodule biopsy and localization in adult thoracic surgery, but its utility in pediatric surgery is unknown. We examined the feasibility of ssRAB including bronchial tree mapping and nodule localization in children.
We identified 14 pulmonary nodules in 11 patients aged 2-18 years on CT scans from 2021 to 2023. We created an additional 34 nodules in an expansion cohort from 17 patients aged 11-months to 17-years to increase sample size. Nodules were categorized as central or peripheral. Bronchoscopy routes were generated with target-to-lesion distance and airway diameter recorded. If the target-to-lesion was greater than 30 mm or airway diameter less than 3 mm, the pathway was manually adjusted. If after manual adjustment the parameters were not met then the pathway was unfeasible.
Of the 11 patients with the existing nodules, 66 % of peripheral nodules (8/12) and 100 % of central nodules (2/2) were feasibly mapped. When examining the feasibility of the expansion cohort 65 % of peripheral nodules (11/17) and 100 % of central nodules (17/17) were mapped. When comparing feasible and unfeasible nodules, there was no difference in patient age and tracheal diameter.
Given the success of our bronchial tree mapping and nodule identification, we conclude that ssRAB is a feasible approach to biopsy and pulmonary nodule localization in children. Peripheral location not age was detrimental to successful mapping. Trialing ssRAB for pediatric lung nodule localization is likely feasible.
Feasibility Study.
Level IV.
肺结节定位对于癌症患儿的许多手术至关重要。形状感知机器人辅助支气管镜检查（ssRAB）是成人胸外科结节活检和定位的首选方式，但其在小儿外科中的效用尚不清楚。我们研究了ssRAB在儿童中进行支气管树绘图和结节定位的可行性。
我们在2021年至2023年的CT扫描中，在11例2至18岁的患者中识别出14个肺结节。我们在一个扩大队列中，从17例11个月至17岁的患者中额外创建了34个结节，以增加样本量。结节被分类为中央型或周围型。生成支气管镜检查路径，并记录靶点到病变的距离和气道直径。如果靶点到病变的距离大于30毫米或气道直径小于3毫米，则手动调整路径。如果手动调整后仍不满足参数，则该路径不可行。
在11例有现存结节的患者中，66%的周围型结节（12个中的8个）和100%的中央型结节（2个中的2个）被成功绘图。在检查扩大队列的可行性时，65%的周围型结节（17个中的11个）和100%的中央型结节（17个中的17个）被绘图。在比较可行和不可行的结节时，患者年龄和气管直径没有差异。
鉴于我们在支气管树绘图和结节识别方面的成功，我们得出结论，ssRAB是儿童活检和肺结节定位的可行方法。周围型位置而非年龄对成功绘图不利。对小儿肺结节定位进行ssRAB试验可能是可行的。
可行性研究。
IV级。
