Airway Registration Approach and Other Determinants of Procedure Efficiency During Shape-Sensing Robotic-Assisted Bronchoscopy.

BACKGROUND

The optimal airway registration strategy for shape-sensing robotic-assisted bronchoscopy (ssRAB) is uncertain. This study explored if "partial" registration improves efficiency of ssRAB while maintaining procedure performance, and investigated other factors impacting procedure duration.

METHODS

A retrospective analysis of prospectively collected data of 201 consecutive ssRABs. Procedures targeting a single lung nodule utilized partial registration, whereas those targeting bilateral nodules received full registration. Registration approach for multiple ipsilateral nodules was per bronchoscopist discretion. Endpoints were compared between registration strategies. Determinants of efficiency were analyzed using multivariate modeling.

RESULTS

Among 201 subjects, 129 (64.2%) received partial registration. The partial approach reduced combined registration and navigation time to the primary nodule by an adjusted 3.1 minutes (95% CI=0.5-5.8; P=0.021) and navigation time by 2.7 minutes (95% CI=0.1-5.3, P=0.041). Total RAB duration was similar between strategies (full +1.7 min, 95% CI=-5.6 to +9.0; P=0.64). Primary nodule virtual-to-live anatomy divergence (partial 24.0%, vs. full 25.0%; P=0.88), localization with a concentric radial-probe endobronchial ultrasound image (partial 63.6%, vs. full 62.5%; P=0.77), and diagnostic yield (partial 85.3%, vs. full 86.1%; P=0.87) were similar between approaches. Several nodule features impacted navigation efficiency, total ssRAB duration, or both.

CONCLUSION

During ssRAB, partial airway registration improves efficiency of the presampling portion of the procedure without sacrificing primary nodule localization and diagnostic yield. Nodule features are important determinants of overall procedure efficiency. The effect of the partial strategy on secondary nodules is unclear. The influence of registration approach on CT-body divergence warrants further study.