Know the Risks and Benefits of Robotic Navigational Bronchoscopy for Lung Cancer

While robotic navigational bronchoscopy is an exciting advancement in diagnosing and staging lung cancer, the procedure does come with some risks and factors to consider, explained one expert.

Robotic navigational bronchoscopy is a new procedure that allows doctors to take nodule samples from an individual’s lung to determine if it is lung cancer. While it can be more accurate and reliable than other methods, robotic navigational bronchoscopy does come with its risks, too, according to Dr. Nathaniel Ivanick, assistant professor of Oncology and Thoracic Surgery at the Roswell Park Comprehensive Cancer Center.

About 5% of individuals who undergo robotic navigational bronchoscopy experience pneumothorax, which is when the air escapes the lung and goes into the chest cavity. However, Ivanick explained that this side effect is very manageable.

Robotic navigational bronchoscopy can also take longer than expected, added Ivanick, who said he prefers to start with a peripheral nodule and then move toward the mediastinum — the area in the chest between the two lungs — to help determine the stage if the biopsy results come back testing positive for cancer.

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Patients should know that these procedures, I feel, when done well, take a bit of time. This is not a 10-minute procedure. This is a procedure where I tend to block off an hour and a half to two hours to do it well. And that's because I start not only with the peripheral nodule, but I also routinely stage the mediastinum afterward. And that's because if I establish a diagnosis of cancer, the next question is, what's the stage? To answer the stage, you need to know what the mediastinum and hilar lymph nodes are showing. To do that, you have to assess with an EBUS (endobronchial ultrasound). So I've had patients come to me and say, ‘Oh, well, I heard on the website, this is only a 10-minute procedure.’ And that's not really accurate and shouldn't be the expectation.

The second thing is complication rate. No invasive procedures are done without complications. But with that being said, (robotic navigational bronchoscopy) has a higher degree of safety than its competitors. So, I generally quote about a 5% risk of pneumothorax. That happens when we injure an edge of lung tissue, and air escapes outside of the lung and goes into the chest. When that happens, we generally can observe and often will need to place a small chest tube to help to reinflate the lung. Again, this is about 5% of the time. But in patients with really bad or advanced emphysema, it can be as high as 10%. Those complications are not unmanageable. They're easily handled within the procedure suite. But there should be a realistic understanding that that is a possibility.

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