Bleeding Risk Assessment with Thromboelastography in Interventional Pulmonology Procedures.

Objective: Thromboelastography (TEG) offers a point-of-care and comprehensive evaluation of the coagulation cascade, but its utility in predicting bleeding risk in Interventional Pulmonology (IP) procedures has not been thoroughly investigated. This study aims to evaluate the effectiveness of TEG in assessing bleeding risk in patients undergoing elective IP procedures.

Material And Methods: Retrospective study of patients who underwent elective IP procedures at Mayo Clinic (Jacksonville, FL, USA) from November 2022 to May 2024.

Diagnostic performance of shape-sensing robotic-assisted bronchoscopy for pleural-based and fissure-based pulmonary lesions.

Background: Sampling of peripheral pulmonary lesions (PPLs) abutting the pleura carries a higher risk of pneumothorax and complications. Although typically performed with image-guided transthoracic biopsy, the advent of shape-sensing robotic-assisted bronchoscopy (ssRAB) provides an alternative diagnostic procedure for this subtype of lesions.

Methods: A retrospective study on PPL attached to the peripheral pleura (PP), comprising costal and diaphragmatic pleura, mediastinal pleura (MP), and fissural pleura (FP) sampled by ssRAB, from January 2020 to December 2023.

Sedation during dynamic bronchoscopy for expiratory central airway collapse: Which is the ideal protocol?

Objective: To compare sedation protocols for dynamic bronchoscopy (DB) in the evaluation of expiratory central airway collapse (ECAC).

Materials And Methods: This observational study included adult patients (≥18 years) referred to Mayo Clinic, Jacksonville, FL, from March 2023 to July 2024, for suspected ECAC. Patients were grouped based on sedation protocols: propofol (Protocol 1), remimazolam (Protocol 2), and remimazolam/fentanyl (Protocol 3).

Expiratory Central Airway Collapse and Pneumatic Stenting With Continuous Positive Pressure Titration: A Technique Description.

Objective: To provide a standardized step-by-step guide for continuous positive airway pressure (CPAP) titration during dynamic flexible bronchoscopy (DB).

Patients And Methods: This descriptive study included patients referred to Mayo Clinic for concern regarding expiratory central airway collapse (ECAC) who underwent DB with CPAP titration from April 5, 2023, to February 9, 2024. Demographic characteristics, comorbidities, pulmonary function test results, and procedural details such as anesthesia protocols, CPAP settings, outcomes of pneumatic stenting, complications, and severity of ECAC were recorded.

Outcomes of lung volume reduction surgery for emphysema: unilateral and bilateral.

Background: Lung volume reduction surgery (LVRS) has historically been performed as a bilateral operation. We aimed to compare the short-term morbidity and mortality between unilateral and bilateral LVRS.

Methods: We performed a retrospective analysis of patients who underwent LVRS for emphysema at two hospital sites over 10 years.

Cryobiopsy versus fine-needle aspiration for shape-sensing robotic-assisted sampling of small lung nodules.

Introduction: Shape-sensing Robotic-assisted Bronchoscopy (ssRAB) has emerged as a promising tool for improved performance when sampling pulmonary nodules (PPN). Previous studies suggest that the 1.1 mm cryoprobe is as effective compared to fine needle aspiration (FNA), for different lesions sizes.

Robotic-assisted bronchoscopy: a narrative review of systems.

Background And Objective: Robotic-assisted bronchoscopy (RAB) has emerged as an advanced technology for lung cancer diagnosis. This review explores the three approved robotic bronchoscopy systems: Ion™ Endoluminal (Intuitive Surgical, Sunnyvale, CA, USA), Monarch™ (Johnson & Johnson, Redwood City, CA, USA), and Galaxy System™ (Noah Medical, San Carlos, CA, USA), and their different operational systems. This narrative review aims to summarize their findings and outcomes for sampling peripheral pulmonary lesions (PPL) suspected of lung cancer.

Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodule Diagnosis during a Single Anesthetic Event.

Introduction: The widespread use of computed tomography as a screening tool for early lung cancer has increased detection of pulmonary lesions. It is common to encounter patients with more than one peripheral pulmonary nodule (PPN) of uncertain etiology. Shape-sensing robotic-assisted bronchoscopy (ssRAB) emerges as a potential alternative to biopsy multiple PPN, in addition to mediastinal staging in single anesthetic procedure.

Shape-Sensing Robotic-Assisted Bronchoscopy versus Computed Tomography-Guided Transthoracic Biopsy for the Evaluation of Subsolid Pulmonary Nodules.

Introduction: Lung cancer remains the leading cause of cancer death worldwide. Subsolid nodules (SSN), including ground-glass nodules (GGNs) and part-solid nodules (PSNs), are slow-growing but have a higher risk for malignancy. Therefore, timely diagnosis is imperative.

Early Pneumatocele Identification Post-Robotic Assisted Bronchoscopy Cryobiopsy: A Case Series Experience.

Introduction: The use of cryobiopsy in conjunction with robotic assisted bronchoscopy is on the rise due to the safety and increased diagnostic yield of cryobiopsy. The incorporation of 3D fluoroscopy in the procedure improves the workflow and helps confirm the accuracy of sampling of peripheral pulmonary nodules.

Methods: We describe an observational series of 12 patients comprising 14 nodules where cryobiopsy was performed during shape-sensing robot-assisted bronchoscopy cryobiopsy under general anesthesia.

Mobile cone-beam computed tomography complementing shape-sensing robotic-assisted bronchoscopy in the small pulmonary nodule sampling: A multicentre experience.

Background And Objective: Shape-sensing robotic-assisted bronchoscopy (ssRAB) has expanded as an important diagnostic tool for peripheral pulmonary nodules (PPNs), with diagnostic yields ranging from 60% to 88%. However, sampling and diagnosing PPN less than 2 cm in size has historically been challenging. Mobile cone-beam computed tomography (mCBCT) has been recently integrated into ssRAB to improve diagnostic accuracy, but its added value remains uncertain.

Atypical distal tracheal fibrous bridge and bronchial stenosis in an adult patient with bronchopulmonary dysplasia.

Tracheobronchial stenosis (TBS) in adults derives from congenital and acquired conditions, including prolonged mechanical intubation, expiratory central airway collapse, infectious or inflammatory disease, and malignancy. The most common clinical presentation is shortness of breath, recurrent infections, and chronic cough. TBS is usually diagnosed via computed tomography or bronchoscopy, with the latter doubling as a therapeutic tool.

Pneumatic stenting in the surgical candidacy assessment for cough variant expiratory central airway collapse.

Expiratory Central Airway Collapse (ECAC) is a multifactorial, underdiagnosed entity that poses unique challenges. Airway stenting is used as a predictor for successful outcomes after central airway stabilization surgery via tracheobronchoplasty (TBP). This approach may pose suboptimal performance in certain ECAC variants.

Novel treatment of bronchopleural fistula in a lung transplant recipient with endobronchial sealant and endobronchial valve placement via robotic-assisted bronchoscopy.

Bronchopleural fistulas (BPFs) are a dreaded complication following pulmonary surgery. Endobronchial valves (EVs), with endobronchial sealant (ES), instilled with robotic bronchoscopy (RB), allow occlusion of BPF, avoiding surgery. The patient was a 71-year-old woman with a history of chronic obstructive pulmonary disease and bronchiectasis who underwent bilateral lung transplantation and wedge resection of the right middle lobe and left lingula.

Clinical Outcomes After Tracheobronchoplasty With Ringed Polytetrafluoroethylene Vascular Graft.

Background: This report describes the surgical technique and outcomes of tracheobronchoplasty (TBP) with ringed polytetrafluoroethylene (PTFE) vascular graft.

Methods: We identified all patients who underwent PTFE-TBP for severe expiratory central airway collapse from January 1, 2018 to August 2021 at Mayo Clinic, Florida. Preoperative and postoperative St George's Respiratory Questionnaire (SGRQ), Cough-Specific Quality of Life Questionnaire (CSQLQ), pulmonary function testing, 6-minute walk test, and blinded dynamic bronchoscopy videos at 3-month follow-up were used to assess outcomes.

One-stop-shop: Lung cancer and pheochromocytoma diagnosed by robotic-assisted bronchoscopy and EBUS scope on a single endoscopic event.

Lung cancer is the deadliest cancer worldwide, therefore, early and prompt diagnosis is essential for better patient outcomes. It is known to have a high predilection for metastasis to the adrenal glands; however, two-thirds of adrenal masses in patients with lung cancer will turn out to be benign, so timely detection is crucial. We present a case of a lung squamous cell carcinoma diagnosed by shape-sensing robotic-assisted bronchoscopy (ssRAB), negative mediastinal and hilar staging with endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA), and a pheochromocytoma diagnosed through endoscopic ultrasound with bronchoscope (EUS-B) fine needle aspiration (FNA) all in the same endoscopic procedure.