B80-4-21 Implementation of Robotic Bronchoscopy in a High Volume Tertiary Care Hospital: Process Analysis and Early Outcomes

Background Robotic-assisted bronchoscopy (RAB) represents a paradigm shift in the diagnosis of small and peripheral pulmonary nodules. While clinical efficacy is established, there is limited evidence on efficient implementation strategies in public healthcare systems. In 2023, ASST Spedali Civili di Brescia, a (2000 bed) Italian public hospital, initiated a comprehensive program for RAB integration. Planning included mapping institutional needs in line with national lung cancer screening recommendations and assembling a multidisciplinary team (pulmonologists, radiologists, clinical engineers, administration, procurement, financial officers, and patient advocates). The process encompassed targeted training protocols for physicians, nurses, and technologists, cost-effectiveness and reimbursement analyses (DRG/tariff refinement), and systematic redesign of the endoscopy suite. Acquisition was achieved through institutional resources and advocacy-led fundraising. Milestones recorded comprised timeline to clinical activation, staff proficiency and engagement, patient access and throughput, and economic indicators. Results Robotic bronchoscopy was implemented without disrupting existing clinical services or workflows. Within the first 11 months, three operators completed training, and 191 patients (representing over 205 nodules) underwent RAB. Per-patient diagnostic yield reached 82.7%, with a complication rate of 2.9% (minor complications), outcomes immediately comparable to those in the international literature, reflecting a shallow learning curve for a rapidly mastered procedure. RAB allowed reliable sampling of much smaller nodules compared to the pre-robotic era (mean diameter 14.7 mm vs. 27 mm), providing increased access to minimally invasive diagnostics in early-stage disease. Timeline from planning to routine practice was under 12 months, supported by optimal DRG tariff application and external fundraising for equipment. Conclusions A rigorous, multidisciplinary approach allows rapid, safe, and economically sustainable integration of RAB into hospital workflows. Success factors include needs-based planning, comprehensive staff training, DRG/tariff optimization, flexible resource management, and stakeholder engagement. The shallow learning curve observed enabled immediate high-level diagnostic performance and patient benefit. This model provides a replicable blueprint for publicly funded institutions seeking to adopt advanced bronchoscopic technologies in compliance with evolving lung cancer diagnostic protocols. This abstract is funded by: None