LAUSR

Since Fielding’s [1] publication of the first human experience of a robotic assisted bronchoscopy platform in this journal in 2019, the scientific and commercial interest for robotic assisted bronchoscopy systems has grown rapidly. Two robotic systems are currently FDA approved and commercially available in the USA: the Auris Monarch® and the Ion® system of Intuitive (CE-approval is still awaited). In this issue, two new studies are presented that study the ability of diagnosing pulmonary lesions with the help of a robotic assisted platform and concurrent imaging technology. Doctors Thiboutot and Argento together with their coworkers investigated which variables of the shape sensing based robot assisted navigation bronchoscopy affect diagnostic outcome in a ventilated cadaver model. In contrast to non-robotized platforms such as electromagnetic navigation technology (EMN), the distal tip of both robotic platforms provide a rigid exit point for needle sampling that can be actively angulated. Interestingly, they show that reducing the distance between the distal catheter and lesion to a minimum was the most important factor affecting diagnostic outcome when having an actively steerable tip. If the distance was kept minimal and the virtual image was manually aligned with the real endoscopic image, the addition of c-arm fluoroscopy and radial EBUS then seemed to result only in a limited increase in accuracy [2]. Also in this issue, in a case study using the Monarch robotic platform, doctor Manley and coworkers showed the feasibility and promising result of using the Monarch robotic platform and needle-based confocal laser endomicroscopy for obtaining real-time sampling guidance and the potential of an image-based diagnosis [3]. With an ever-increasing amount of incidentally and screening detected nodules, the interventional pulmonologist is challenged to accurately reach and diagnose even the smallest of lesions. Furthermore, it is likely that image guided transbronchial treatments for malignant nodules will also be added to our inventory in short-term as well [4]. The diagnostic accuracy of available combinations of technologies such as c-arm fluoroscopy, thin bronchoscopes, radial EBUS miniprobes, EMN, and virtual navigation bronchoscopy therein all seem to ap-