Event Specialty: Bronchoscopy
*Dr. Yasufuku is the Director of Interventional Thoracic Surgery & Endoscopy at the University of Toronto. *
At the Society of Thoracic Surgery's Tech-Con Meeting, Dr. Yasufuku presented on the novelty of robot bronchoscopy and potential diagnostic and therapeutic applications within thoracic surgery. This presentation marked the first public introduction of the Monarch Platform to a thoracic surgeon audience.
Auris’s goal with the Monarch Platform is to help thoracic surgeons better diagnose and treat lung tumors in the early stages. With traditional, manual bronchoscopy techniques, there is no diagnosis a significant number of procedures. With the Monarch Platform’s flexible robotics, it is designed to help thoracic surgeons navigate to difficult-to-reach areas in the periphery of the lung with great precision and accuracy. This may eliminate the need for more invasive procedures to obtain a diagnosis. Early diagnosis of lung cancer can lead to a better prognosis for patients. Current statistics show that a large percentage of those diagnosed with lung cancer do not survive because the disease is typically discovered in more advanced, inoperable stages.
The Society of Thoracic Surgery is the largest organization to represent thoracic and cardiovascular surgeons, with its annual conference bringing together active attendees with educational innovation. Meetings typically feature “interactive learning on hot topics, including thought-provoking lectures from renowned faculty and guests, exciting hands-on sessions, an abundance of networking opportunities, and a chance to view the latest products and services in the specialty.” The Society's 54th Annual Meeting was hosted in Ft. Lauderdale, Florida and gathered more than 4,000 attendees, including approximately 2,200 cardiothoracic surgeons.
Sources: - Sandeep J. Khandhar, Mark R. Bowling, Javier Flandes, et. al.; Electromagnetic navigation bronchoscopy to access lung lesions in 1,000 subjects: first results of the prospective, mulitcenter NAVIGATE Study
Ost DE, Ernst A, Lei X, et al. Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med. 2016;193(1):68–77. doi:10.1164/rccm.201507-1332OC
Rivera MP, Mehta AC; American College of Chest Physicians. Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132(suppl 3):131S–148S.
Wang Memoli JS, Nietert PJ, Silvestri GA. Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest 2012; 142:385–393.
Seijo LM, de Torres JP, Lozano MD , et al. Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a Bronchus sign on CT imaging: results from a prospective study. Chest 2010; 138 (6) 1316-1321
Complications from bronchoscopy are rare and most often minor, but if they occur, may include breathing difficulty, vocal cord spasm, hoarseness, slight fever, vomiting, dizziness, bronchial spasm, infection, low blood oxygen, bleeding from biopsied site, or an allergic reaction to medications. Only rarely do patients experience other more serious complications (for example, collapsed lung, respiratory failure, heart attack and/or cardiac arrhythmia).
Adverse effects from both Mini-PCNL and Ureteroscopy include pain, urinary tract infection, fever, hematuria (presence of blood in urine), exposure to low levels of radiation, retained or residual stones.
Adverse effects from ureteroscopy may include pain, perforation or injury to the ureter, resulting in extravasation of fluid and urine (urinoma), stricture of the ureter with risk of subsequent obstruction (hydronephrosis needing further repair), rare avulsion of the ureter, urinary blood clots, residual stones.
PCNL access may result in minor and major adverse effects. Minor effects include fever and nephrostomy leak. Major adverse effects may include injuries to pleura, liver, spleen, large vessels with related bleeding, gallbladder, duodenum, jejunum, colon with related cutaneous fistula, fever, pain, ileus, elevated counts.
Major adverse effects related to stone removal may include infection and urosepsis, intravascular fluid overload, extravasation of fluid, and post percutaneous nephrolithotomy bleeding.