Bronchoscopy is a longstanding method for diagnosing lung cancer, particularly effective for detecting early-stage lesions (Stages 1 - 2). Commonly, lung cancers are identified when the nodule or spot has grown significantly, with cure rates ranging between 64-70% for tumors approximately 30mm in size, assuming no further metastasis has occurred. Diagnosing nodules in the peripheral lung presents additional challenges due to the narrowing and bending of the bronchi, which can obstruct the bronchoscope's path. This often necessitates multiple biopsies before a definitive diagnosis, potentially prolonging a patient’s pathway to treatment. Now, a minimally invasive bronchoscopy platform helps shorten the patient journey by enabling access to and biopsy of hard-to-reach nodules in the peripheral lung, where over 70% of cancerous lung nodules are found.

Intuitive Surgical’s (Sunnyvale, CA, USA) Ion (Ion endoluminal system) represents a significant advancement in diagnostic technology, facilitating robotic-assisted tissue sample collection from virtually any lung nodule. Ion’s highly flexible, maneuverable catheter allows clinicians to access small lesions across all 18 lung segments with greater reach, precision, and stability. This capability ensures the safe and efficient collection of lung tissue samples for biopsy, even when nodules are small and situated in hard-to-reach peripheral locations. Ion is distinctive in that it employs shape-sensing technology to provide continuous, precise feedback on the catheter’s location, shape, and orientation by measuring its form hundreds of times per second during navigation and biopsy.

Ion provides a comprehensive view of the catheter’s position within the airway through a 3D real-time visualization made possible by shape-sensing technology. Additionally, Ion offers 2D direct visualization at the tip via a vision probe. The camera and biopsy tools are accommodated within the same channel, maintaining the catheter's ultra-thin diameter, which is crucial for navigating narrow passages and sharp turns. Real-time shape sensing aids in visual positioning and orientation, enhancing navigation and biopsy accuracy. The catheter, which can articulate 180° in any direction, features a thin fiber optic shape sensor embedded within a 3.5 mm outer diameter wall with a 2 mm working channel. It responds dynamically to physician commands via Ion’s trackball and scroll wheel. Advanced real-time shape-sensing technology combined with robotic control algorithms enables the Ion catheter to maintain its position once the target nodule is reached. The Ion system integrates seamlessly with Siemens Healthineers’ (Forchheim, Germany) Cios Spin mobile imaging system to perform 3D scans that are automatically transmitted to Ion, allowing physicians to refine navigation and confirm tool-in-lesion using a touchscreen. 

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