Advancements in Robotic-Assisted Bronchoscopy: Transforming Emergency Room Decision-Making

Robotic-assisted bronchoscopy now demonstrates markedly improved lesion targeting and diagnostic precision for peripheral pulmonary nodules.

Electromagnetic navigation, shape‑sensing catheters, articulated robotic control, and biopsy‑tool compatibility extend reach into distal airways and stabilize tool‑in‑lesion during sampling. These advances materially improve targeting compared with legacy bronchoscopy and navigation, providing the mechanistic basis for higher diagnostic yield.

Intra‑procedural multimodal imaging refines real‑time targeting and confirms tool‑in‑lesion when combined with radial endobronchial ultrasound, cone‑beam CT, and fluoroscopy. That imaging integration reduces nondiagnostic samples and links immediate confirmation to higher biopsy accuracy.

Escalation to RAB is most reasonable when a patient has a peripheral pulmonary nodule with intermediate‑to‑high pretest probability for malignancy, lesion characteristics that favor bronchoscopic access (size and presence of a bronchus sign), and when same‑session tissue diagnosis would change immediate disposition. CT‑guided percutaneous biopsy remains an alternative for very peripheral or pleura‑abutting lesions but carries higher pneumothorax risk. Observation with short‑interval imaging is appropriate when diagnostic intent will not alter acute management; surgical referral is preferred for lesions requiring resection or when bronchoscopic access is unlikely.