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A 73-year-old female was referred by her primary care physician for a lung mass located in the left upper lobe. The patient was initially put on a CT surveillance protocol due to the granulomatous characteristics of the mass and the proximity to the heart. The patient was sent to pulmonary for a MONARCH® Robotic-Assisted Bronchoscopy. This was the physician’s initial experience with the platform.
Procedure initialization and navigation to the target were completed within 7 minutes of scope insertion. (Fig. 1) Radial EBUS (REBUS) was used to confirm the location and displayed an eccentric view of the targeted area. (Fig. 2) A 2 cm length, 21G flexible needle was inserted just distal to the end of the scope to penetrate the airway wall. (Fig. 3) Precise microadjustments were made with the MONARCH® scope to align the needle tip with the correct trajectory to the target. (Fig.4) Direct visualization and fluoroscopy were used to confirm the needle traversed through the airway wall and instrument slippage was mitigated. Additional biopsies were attained using small positional changes in a grid-like fashion around the area in question.
The pre-procedure suspicion of granuloma was ruled when final pathology results confirmed a diagnosis of early stage adenocarcinoma. The patient was referred to surgery for a lobectomy of stage 1 cancer.
A new biopsy optimization technique consisting of simultaneous scope manipulation & biopsy tool deployment with live vision achieved a diagnosis in our first MONARCH procedure.
The integrated camera design of the MONARCH® Platform afforded the ability to make small controlled adjustments with the tip of the scope while also deploying tools to achieve the ideal trajectory and evaluate for tissue engagement. The MONARCH® controller allows for a seamless one-handed approach to passing instruments and making positional changes. These features played an integral role in obtaining a diagnosis for this patient.
Memorial Health University Medical Center, Savannah, GA Dr. Jason McClune is a Pulmonary Disease & Critical Care physician based in Savannah, GA. He has more than 15 years of experience in pulmonary disease and his clinical interest include diagnosing and treating lung and breathing problems.
Indications for Use: The MONARCH® Platform and its accessories are intended to provide bronchoscopic visualization of and access to patient airways for diagnostic and therapeutic procedures.
Important Safety Statement: 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. It is uncommon for patients to experience other more serious complications (for example, collapsed lung, respiratory failure, heart attack and/or cardiac arrhythmia).
This document reflects the techniques, approaches and opinions of the individual physician. This Auris sponsored document is not intended to be used as a training guide. Other physicians may employ different techniques. The steps demonstrated may not be the complete steps of the procedure. Individual physician preference and experience, as well as patient needs, may dictate variation in procedure steps. Before using any medical device, review all relevant package inserts with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device(s).
Dr. Jason McClune is compensated by and writing on behalf of Auris Health and must present information in accordance with applicable FDA requirements.
Bronchoscopy:
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).
Urology:
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.