CHEST 2021: Abstract

Rationale

Despite growing experience using advanced guided techniques, the diagnostic yield of bronchoscopy for peripheral pulmonary lesions remains suboptimal, particularly for lesions which are adjacent to peripheral bronchi. While recent publications have focused on improving bronchoscopic reach and access to the lung periphery, few have addressed significant modifications to the instrumentation used to obtain biopsies.

Objectives

This exercise was performed to evaluate two novel, steerable instruments within human cadaveric lungs with simulated tumor targets. Instrument assessment included the ability of both instruments to access simulated tumor targets in all lobes of the lung, as well as to reposition instruments within tumor targets.

Methods

Artificial tumor targets were placed in all lobes of the lungs of two human cadaver torsos. Bronchoscopists utilized a large caliber bronchoscope (BF-1TH190, Olympus, Tokyo, Japan) and steerable guide sheath (2.7mm OD, SerpeX Medical, Santa Clara, CA) by advancing, rotating and articulating the distal end of the guide sheath towards the targeted lesion using fluoroscopic guidance and a reference CT scan. Radial probe endobronchial ultrasound (UM S20-17S, Olympus Tokyo, Japan) was used to confirm lesion localization prior to performing transbronchial needle aspiration (Periview Flex, Olympus, Tokyo, Japan) and transbronchial biopsy (Precisor Broncho Forceps, ConMed, Utica, NY). Following this, a standard diagnostic bronchoscope (BF-H190, Olympus, Tokyo, Japan) was used to advance a steerable needle (1.8mm OD, SerpeX Medical, Santa Clara, CA) towards the same targeted lesions using insertion, rotation and articulation of the distal tip.

Measurements and Main Results

Both the steerable sheath and steerable needle were successfully placed within simulated tumor targets in all lobes of two cadaveric lungs with diagnostic biopsy material obtained from all lobes. Additionally, manipulation of the distal end of the steerable sheath and steerable needle was successfully used to reposition each tool within different locations of the same lesion (Figure 1).

Conclusions

This is an initial reporting of two fully articulating, steerable instruments designed to assist with bronchoscopic biopsy of peripheral lung lesions. In this exercise both instruments were successfully positioned within tumor targets in all lobes of two human cadaveric lungs. Additionally, articulation and rotation of the distal end of each of these instruments successfully repositioned biopsy instruments within different locations of targeted lesions.

link: https://journal.chestnet.org/article/S0012-3692(21)03254-2/pdf