B80-4-20 Diagnostic Yield and Lesion Size in Robotic Versus Traditional Bronchoscopy: A Single-Center Comparative Study

Abstract Background Recent advances have significantly expanded the diagnostic reach of bronchoscopy for peripheral pulmonary nodules. Robotic-assisted bronchoscopy (RAB) enables precise and safe access to smaller, more distal lesions, prompting renewed interest in benchmarking its real-world performance against traditional approaches. Methods A retrospective cohort study was performed in a tertiary Italian public hospital, evaluating consecutive cases of bronchoscopic biopsy for peripheral lung nodules over two distinct timeframes. The pre-robotic cohort included 200 nodules biopsied with traditional bronchoscopy (fluoroscopy + radial EBUS) between April 2023 and December 2024. The post-implementation cohort included 205 nodules from 191 patients sampled via RAB between December 2024 and October 2025, following comprehensive operator training and workflow adaptation. All robotic procedures were performed using the Ion™ robotic bronchoscopy system (Intuitive Surgical) with Artis Zee fluoroscopic guidance (Siemens); in 9 cases, a GE 3D C-arm was utilized to enable robotic-imaging integration for real-time navigation confirmation. Primary outcomes analyzed were diagnostic yield (per patient), complication rate, mean nodule diameter, and procedure duration. Results The traditional cohort targeted nodules with a mean diameter of 27 mm, achieving a diagnostic yield of 78%. The RAB cohort targeted significantly smaller lesions (mean diameter 14.7 mm) with a per-patient diagnostic yield of 82.7% (158/191 patients; per-nodule yield 81.5%). Complication rates remained low (2.9%, 6/205 procedures), and mean procedure duration with RAB (41 minutes) was not increased compared to standard methods. Notably, the RAB cohort included 61.5% small nodules (≤15 mm) with a diagnostic yield of 76.2%, and 30.7% very small nodules (≤10 mm) with a diagnostic yield of 68.3%, demonstrating effective access to challenging peripheral lesions. The learning curve for RAB was shallow, with diagnostic performance and safety metrics comparable to published literature from the outset. RAB expanded access to minimally invasive diagnosis, permitting sampling of nodules nearly half the size previously accessible, with non-inferior safety and efficiency. Conclusions Robotic-assisted bronchoscopy markedly enhances diagnostic yield for smaller and more peripheral nodules compared to traditional bronchoscopic methods, without increasing procedural risks or compromising efficacy. Adoption of RAB enables a broader swath of patients - particularly those with early-stage, small-volume lesions - to benefit from precise, minimally invasive diagnostic strategies. These data strongly support the integration of robotic platforms into the diagnostic algorithm for peripheral pulmonary nodules in modern interventional pulmonology. This abstract is funded by: None