D24-25 CBCT-Based 3D Fusion Navigation-Assisted Bronchoscopic Intervention for Recanalization of Completely Scar-Obliterated Bronchus

Introduction Postsurgical cicatricial bronchial occlusion represents a severe complication following pulmonary or bronchoplastic surgery, with a low success rate of recanalization using conventional bronchoscopic interventions. Cone-beam computed tomography (CBCT) combined with augmented reality (AR)-based three-dimensional fusion navigation enables real-time localization and precise instrument guidance, offering a novel approach for complex airway recanalization. Case Report A 53-year-old man had undergone right carinal tumor resection and carinoplasty two years earlier for adenoid cystic carcinoma of the bronchus. Fourteen months before presentation, he developed progressive dyspnea and recurrent pulmonary infections. Imaging and bronchoscopy at an outside hospital revealed cicatricial occlusion of the right intermediate bronchus with partial atelectasis of the right middle and lower lobes; several endoscopic interventions had failed to reopen the airway. Upon admission, multidisciplinary evaluation confirmed residual aeration in distal lung parenchyma, indicating potential for recanalization. Three repeated conventional bronchoscopic attempts were unsuccessful. A CBCT-guided procedure using three-dimensional fusion navigation was therefore undertaken. Under real-time CBCT guidance, a 21G puncture needle was advanced precisely through the occlusion. After multiple directional adjustments, a patent channel was established; electrocautery release and balloon dilatation were subsequently performed, followed by aspiration of large amounts of purulent secretions. At one-month follow-up, bronchoscopy demonstrated a stable lumen with moderate residual stenosis in the right intermediate bronchus and normal patency of the right middle/lower lobe openings. Four months postoperatively, CT confirmed sustained lumen patency and partial re-expansion of the involved lung segment, with significant symptomatic improvement. Discussion Current adjunctive navigation techniques for complex airway recanalization include virtual bronchoscopy navigation (VBN), electromagnetic navigation bronchoscopy (ENB), and fluoroscopic guidance. However, VBN and ENB cannot dynamically reflect intraoperative anatomical changes and are often inadequate for cases of complete obstruction. In contrast, CBCT combined with AR-based 3D fusion enables real-time spatial registration and three-dimensional orientation, satisfying the demands of multi-axis procedural maneuvers. Compared with conventional bronchoscopy, CBCT-guided puncture substantially increases the “first-attempt success rate” for traversing complex occlusions, while markedly reducing procedure-related complications. In this case, successful recanalization was achieved despite complete obstruction and prior failure of standard techniques, demonstrating the superior precision, safety, and efficiency of CBCT-based 3D navigation in managing anatomically challenging airway stenoses.