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9th Nov, 2026 12:00 AM

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Robotic Assistance Boosts Safety in Lung Biopsy

Shape-sensing robotic-assisted bronchoscopy (ssRAB) was associated with significantly fewer complications than CT-guided transthoracic biopsy (CTTB), based on data presented at the Annual Conference of the American Association for Bronchology and Interventional Pulmonology.

Although CTTB remains a common technique for diagnosing pulmonary lesions, it carries a risk for multiple complications, including pneumothorax, said Arunava Saha, MD, a pulmonary and critical care fellow at Tulane University School of Medicine, New Orleans.

“Advances in bronchoscopic technology, including [ssRAB] with cone-beam CT [CBCT] have expanded the bronchoscopic reach to peripheral lung lesions while potentially reducing complication rates,” Saha noted. However, real-world data comparing diagnostic outcomes and safety are limited, he said.

Saha and colleagues reviewed data from 106 patients who underwent biopsies of peripheral pulmonary lesions using ssRAB and 50 who underwent biopsies using CTTB. The mean age of the participants was 67.2 years, and the two groups had similar baseline characteristics including BMI, smoking history, and final diagnoses. The primary outcome was diagnostic yield, defined as a benign historical diagnosis or malignant pathology.

Article Key Points

ssRAB sensitivity 82.6% vs CTTB 88.4%; difference NS.
Complications markedly lower with ssRAB vs CTTB: 2.8% vs 42.0%.
Pneumothorax was the most common complication in both biopsy groups.
ssRAB biopsied smaller nodules; mean lesion size 5.4 mm smaller.
Retrospective data support ssRAB as safer for higher-risk patients.

Dive Deeper

How does ssRAB compare with CTTB for peripheral lesion yield?

Which factors predict pneumothorax after transthoracic lung biopsy?

Does cone-beam CT improve ssRAB diagnostic accuracy?

Overall, ssRAB and CTTB showed similar sensitivity (82.6% and 88.4%, respectively), with 95% CIs of 68.58%-92.18% and 79.65%-94.28%, respectively (P = .88). However, the complication rate was significantly higher in the CTTB group than in the ssRAB group (42.0% vs 2.8%). Pneumothorax was the most common complication in both groups. The average nodule size in the ssRAB group was 5.4 mm smaller than that in the CTTB group, the researchers noted.

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The findings were limited by the retrospective design, the researchers said. However, the lower complication rate supports ssRAB as a safer alternative to performing pulmonary lesion biopsies, especially for patients at increased risk for procedure-related complications, they concluded.

The study received no outside funding. The researchers had no financial conflicts to disclose.

Dive Deeper

Commonly Asked by HCPs

Q: How are shape-sensing robotic bronchoscopy and conventional bronchoscopy used for peripheral nodules?

A: Shape-sensing robotic bronchoscopy is designed to improve navigation to peripheral lesions while maintaining bronchoscopic safety advantages. Clinicians researching this approach typically look for evidence on lesion reach, diagnostic yield, adjunct imaging such as cone-beam CT, and how robotic platforms compare with conventional bronchoscopy for peripheral nodule biopsy.

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Q: Which patients are best candidates for robotic-assisted bronchoscopy of peripheral pulmonary lesions?

A: Candidates for robotic-assisted bronchoscopy generally include patients with peripheral pulmonary nodules that are challenging to access bronchoscopically but still suitable for airway-based navigation. Physicians often evaluate lesion location, bronchus sign, size, bleeding risk, comorbid lung disease, and the need to minimize complications when selecting a biopsy approach.

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Q: When should peripheral lung lesions be biopsied bronchoscopically versus transthoracically?

A: Peripheral lung lesions are often approached with either bronchoscopic or transthoracic sampling, depending on lesion size, location, airway access, and local expertise. Research commonly focuses on balancing diagnostic yield with procedure-related risks such as pneumothorax, bleeding, and need for repeat sampling, especially when lesions are small or difficult to reach.

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Q: What factors increase pneumothorax risk after transthoracic lung biopsy?

A: Pneumothorax risk after transthoracic lung biopsy is influenced by lesion depth, pleural distance, emphysema, needle path length, and patient respiratory factors. Research also addresses how lesion characteristics and technique selection affect complication rates, along with when postprocedure imaging and observation are needed.

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Q: How do diagnostic yield and complication profiles compare across lung biopsy techniques?

A: Diagnostic yield and safety are the key tradeoffs across lung biopsy techniques. Bronchoscopic approaches often offer lower pneumothorax risk, while transthoracic biopsy may provide high yield for certain lesions; comparative research usually examines lesion accessibility, need for ancillary imaging, repeat procedures, and overall complication burden.

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