B80-4-22 Diagnostic Yield of Robotic Bronchoscopy in a Single Veterans Affairs Health Care System

Abstract Background Robotic bronchoscopy has emerged as an advanced, minimally invasive modality for the diagnosis of peripheral pulmonary nodules. Compared with conventional bronchoscopy, robotic systems provide superior navigation accuracy, reach to distal airways, and procedural stability, potentially improving diagnostic yield while maintaining safety. Despite these advantages, real-world data remain limited, with reported yields varying across centers depending on lesion characteristics, operator experience, and procedural workflow. Methods We conducted a retrospective, single-center study of patients who underwent robotic bronchoscopy for evaluation of pulmonary nodules between 2022 and 2024. Demographic, clinical, and radiologic data were extracted from the electronic medical record. Nodule size was measured as the mean of three orthogonal dimensions on pre-procedural CT imaging. Location was categorized as central, middle, or peripheral based on the bronchial generation of the target airway. Lobar distribution was also recorded. Diagnostic yield was defined as positive when a specific malignant or benign pathology was established (e.g., adenocarcinoma, squamous cell carcinoma, granulomatous or infectious disease) and negative when findings were non-diagnostic or indeterminate. Procedural complications were documented and graded according to established bronchoscopy safety criteria. Results A total of 64 patients were included. The mean nodule size was 22.4 ± 13.7 mm. Of the nodules evaluated, 39.1% were located centrally, 32.8% in the middle zone, and 28.1% peripherally. With respect to lobar distribution, 34.4% were in the right upper lobe, 29.7% in the left upper lobe, 20.3% in the right lower lobe, 12.5% in the left lower lobe, and 3.1% in the right middle lobe. The overall diagnostic yield was 80%, with 51 positive and 13 negative results (including 9 non-diagnostic and 4 suspicious cases). Positive diagnoses included both malignant and specific benign pathologies such as granulomatous or infectious disease. Complications were infrequent: one patient experienced grade 2 bleeding that was managed conservatively, and one developed a pneumothorax not requiring chest tube insertion. No severe or life-threatening adverse events were observed. Conclusion In this single-center experience, robotic bronchoscopy achieved a diagnostic yield of 80% for pulmonary nodules with a mean diameter of 22 mm, with minimal complications. These findings support the safety and effectiveness of robotic bronchoscopy in the diagnostic evaluation of indeterminate lung nodules and underscore its expanding role in early lung cancer detection and minimally invasive pulmonary diagnostics. This abstract is funded by: None