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Diagnosis of 10 mm Right Middle Lobe Nodule through Lung Screening Program

Dr. Robert Kruklitis

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Fig 3. MONARCH® navigation screen showing airway bifurcation
Fig 3. MONARCH® navigation screen showing airway bifurcation


A 74-year-old male with a smoking history of 59 pack-years was enrolled into the hospital lung cancer screening program through his primary care provider. The patient was asymptomatic, and imaging revealed a small 10 mm lung nodule located in the right middle lobe. Follow up included a PET scan which was suspicious for malignancy. The patient was referred to pulmonary for a Robotic-Assisted Bronchoscopy with the MONARCH® Platform.


The MONARCH® Planning software revealed a 10 mm small nodule located in the right middle lobe. A definitive bronchus sign was identified leading to the nodule.

Within three minutes of navigation the MONARCH® Platform was able to get within 17 mm of the center of the lesion. Once proper positioning of the robotic scope was achieved, fluoroscopy was used to confirm location. Radial EBUS was then deployed into the working channel and a concentric pattern was observed while maintaining continuous visualization of the airway. Multiple biopsies were performed under direct observation with the MONARCH® scope. Final pathology results revealed Carcinoid.

"MONARCH® Platform gave me the added stability and control to access a difficult to reach area of the lung."


Utilization of the MONARCH® Platform for this small lung lesion was successful due to the ability to access the periphery of the lung. Stability and control of the robotic scope allowed for sampling in a difficult area and continuous vision provided additional information on tool manipulation that was used to attain tissue. This primary lung cancer was found in an asymptomatic patient through the hospital lung screening program which ultimately led to a sooner transition to therapeutic intervention. The patient has been referred to radiation oncology and thoracic surgery for recommendations on best course of care.

Dr. Robert Kruklitis

About Robert Kruklitis, M.D.

Lehigh Valley, Allentown, PA
Dr. Robert Kruklitis is a pulmonologist in Allentown, Pennsylvania and is affiliated with Lehigh Valley hospital. He received his medical degree from Georgetown University School of Medicine and has over 24 years of experience in his field.

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).