LAUSR

Electromagnetic navigation bronchoscopy (ENB) was designed to extend bronchoscopy to the peripheral airways beyond where can be approached via traditional bronchoscopy by using software-based reconstructed virtual airway and hardware-based real-time navigation. When compared with traditional bronchoscopy, ENB significantly increases the overall diagnostic yield in the biopsy of peripheral pulmonary lesions (1). To deploy biopsy tools or conducting other transbronchial interventions, the extended working channel (EWC) of ENB should be fixed in a position toward the target lesion. Various adjuvant techniques can be used to verify the direction of EWC during ENB. Fluoroscopy is generally used in reported series to examine the position of the EWC, whereas some lesions, especially those with ground-glass opacity can be hard to visualize during X-ray. Linear endobronchial ultrasound is usually adopted when simultaneous lymph node assessment is required or dealing with more challenging cases. In a recently published prospective, multicenter study evaluating ENB for peripheral pulmonary lesions (the NAVIGATE trial), fluoroscopy, endobronchial ultrasound, and cone-beam CT was used in 91, 57.4, and 4.9%, respectively (2). Notably, the application of the hybrid operating room (OR) in the minimally invasive thoracic procedure is rapidly gaining acceptance in recent years (3). The incorporated DynaCT within the hybrid theater provides unparalleled real-time images in high resolution which could improve location confirmation and visualization during ENB navigation. In the current mini-review, we discussed the ENB-guided pulmonary nodule biopsy and localization technique, as well as transbronchial local treatment in hybrid OR.