Lung conditions such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, and lung cancer remain leading causes of morbidity and mortality worldwide. As the demand for earlier, more accurate diagnoses and minimally invasive treatment options grows, healthcare professionals are turning to advanced technologies that can deliver both. 

One such breakthrough is the endoluminal system—a transformative approach that combines diagnostic precision with therapeutic potential inside the airways. Here, Dr. Raju Abraham, pulmonologist with Riverside Medical Group, discusses how endoluminal systems are reshaping the landscape of pulmonary care, offering new hope for patients and powerful tools for clinicians.

Advances in Lung Imaging Capabilities

Bronchoscopy, a method for viewing a person’s airways, has seen significant advancements in recent years. Traditional bronchoscopy offered limited access to peripheral lung lesions, but the introduction of electromagnetic navigation bronchoscopy improved diagnostic accuracy to about 60–70% when cases were carefully selected. However, even that had limitations. 

The latest innovation—robotic bronchoscopy—allows clinicians to reach small, hard-to-access nodules in the lungs, enabling earlier and more accurate cancer diagnoses, including the detection of multiple cancers at once. “What I have been finding is that we are sometimes getting two diagnoses on the same patient, with two nodules. It doesn't happen all the time, but it does happen frequently enough to say that we need to be doing this more often than we ever thought before,” states Dr. Abraham. 

What Does This New Approach to Bronchoscopy Involve?

Ion robotic bronchoscopy requires a specially formatted CT scan with thinner slices than standard scans, following the ion protocol. At Riverside, the radiology team prepares the scan, which is then uploaded to a computer to create a precise roadmap to the lung lesion. The scan should be done within a month of the procedure to ensure anatomical accuracy. 
During the procedure, which is performed under general anesthesia to prevent movement, a GPS-like system guides the catheter to the lesion. Ultrasound is used to confirm the correct position, and a cone beam CT provides a 3D image to further verify and adjust catheter placement as needed.

As far as accuracy goes, Dr. Abraham is very pleased with the results. “Traditional bronchoscopy used to be about at a forty percent success. The electromagnetic navigation went to around sixty percent. With ion robotic bronchoscopy, we can see from eighty to ninety percent,” he notes.

Robotic bronchoscopy is typically performed as an outpatient procedure. After recovery, patients can usually go home the same day, provided there are no complications. While rare, potential complications like bleeding or lung collapse may require extended observation, but most patients are discharged without issue. Results are usually available within 24 to 72 hours.

What Sets Ion Robotic Bronchoscopy Apart from the Traditional Method?

The ion robotic bronchoscopy system offers a safer alternative to traditional methods like CT-guided biopsy. While both approaches have similar diagnostic accuracy (80–90%), CT-guided biopsies carry a higher risk of complications—especially pneumothorax, which occurs in about 20% of cases and may require a chest tube. In contrast, the ion system significantly reduces this risk while still delivering high diagnostic yield.

“When we started wanting to do this, I was worried how the radiologists would take it. And when I spoke to radiology, they told me they were very happy about it because that was one biopsy they didn't want to do. The lungs,” shares Dr. Abraham. “They didn't mind doing any other biopsies, but the lung biopsy put them under a lot of pressure because of potential for pneumothorax and then having to treat that. So, they actually went out of their way to help us get this started.”

Ion Robotic Bronchoscopy: Better for Providers and Patients Alike

Ion robotic bronchoscopy streamlines the diagnostic process by potentially eliminating extra steps required after a CT-guided biopsy. With CT-guided biopsies, if lung cancer is detected, patients still need a PET scan and an endobronchial ultrasound bronchoscopy to accurately stage the cancer—especially to detect small metastases in the mediastinal lymph nodes. The ion system, however, can combine diagnosis and staging more efficiently, reducing the need for multiple separate procedures.

“The advantage of the robotic bronchoscopy is that since the patient is already under anesthesia, we do both at the same time. We do the robotic bronchoscopy and then proceed on to do the endobronchial ultrasound to look at the mediastinal lymph nodes and see if there is a malignancy. It saves an extra procedure for the patient,” explains Dr. Abraham. 

Who Is a Good Candidate for Ion Robotic Bronchoscopy?

While most candidates for ion robotic bronchoscopy are patients with suspected lung cancer, the procedure is also valuable in other scenarios. It can help identify metastases from other cancers or distinguish between multiple disease processes in the same patient—an increasingly common situation as cancer treatments improve and patients live longer. 

Additionally, the procedure can detect non-cancerous conditions, such as infections that present as lung nodules. This makes Ion bronchoscopy a versatile tool for diagnosing both malignant and benign lung conditions, allowing for more precise and tailored treatment plans.

Dr. Abraham assures patients that everyone involved in treating lung conditions is aware of and on board with the latest innovations. “We have talked to the oncologists. The radiologists are also aware, and our primary care physicians are in the know because we presented the option at a retreat and reassured them the pulmonologists are available. That means absolutely everyone in the department is available. If anyone needs a robotic bronchoscopy, their primary can just send them to us and we can take care of it from there.”

For more information  on pulmonary medicine at Riverside Healthcare, call (815) 933-3814. For more information on the ION Robot-Assisted Procedure, click here.