B80-4-44 Diagnostic Yield And Safety Of Robot-assisted Versus Conventional Navigational Bronchoscopy For Peripheral Pulmonary Nodules: A Systematic Review And Meta-analysis

Rationale

Recent advancements in lung cancer screening programs have led to the increased detection of peripheral pulmonary nodules (PPNs). While early detection is associated with reduced mortality rates, the accurate diagnosis of these nodules remains challenging. Conventional navigational bronchoscopy (CNB), encompassing techniques such as electromagnetic navigation bronchoscopy (ENB), virtual bronchoscopic navigation (VBN), and radial endobronchial ultrasound (rEBUS), has demonstrated superiority over standard bronchoscopy. However, CNB encounters difficulties with small nodules (<20 mm) due to catheter instability and discrepancies between computed tomography (CT) images and the patient’s anatomy. Robot-assisted bronchoscopy (RAB) is an emerging technology designed to address these limitations by providing enhanced stability and reach.

Objectives

This study systematically reviews and meta-analyzes the diagnostic yield (DY) and safety of RAB versus CNB in adults with PPNs.

Methods

A systematic search was conducted in PubMed/MEDLINE, Scopus, and OpenAlex for comparative studies (RCTs and observational) published between 2015 and 2025. The primary outcome was DY and secondary outcomes included complications. Risk of bias was assessed using Cochrane RoB 2 and NOS tools. A random-effects model was used to calculate pooled risk ratios (RR).

Results

The search yielded 142 records, from which three pivotal studies (one cluster-RCT and two retrospective cohorts) involving 678 nodules were synthesized. Included studies utilized advanced imaging (CBCT or digital tomosynthesis) in RAB and select CNB arms. Compared to ENB, RAB exhibited a non-significant trend towards higher yield (RR 1.11; 95% CI 0.96-1.28; p = 0.17), with substantial heterogeneity (I2 = 72%). However, RAB demonstrated statistically significant superiority over VBN (RR 1.30; 95% CI 0.99-1.71; p = 0.05). Safety profiles were comparable, with pneumothorax rates of 0%-2.0% in RAB versus 2.1%-6.9% in CNB. Limitations included the small number of studies and design heterogeneity.

Conclusion

RAB offers diagnostic yields comparable to advanced ENB and superior to VBN, maintaining a high safety profile. The integration of intraprocedural imaging (CBCT/tomosynthesis) appears to synergize with RAB’s stability to enhance outcomes in complex anatomical scenarios.

This abstract is funded by: None