In patients that have pulmonary nodules that are worrisome for lung cancer that
might be enlarging over time or have shown to be enlarging over time biopsying those nodules is important to get a diagnosis. I have been doing
bronchoscopy for over 20 years. I didn't think I would see robotic-assisted
bronchoscopy actually in my career. In the past we've been using navigational
technologies to access those nodules or to try to get close to biopsying
those nodules. The problems with the technology of the past is that the
scopes were too big. The tools were not good enough to stop the scope from
flexing into a segmental airway so now we have robotic bronchoscopy allowing us
much better precision, much better control in the airway, much better
anatomical alignment for the physician actually driving the scope. We're
actually driving the scope with a gaming controller and we're able to steer in
any segmental airway that we want to. The optics now are amazing and then the
ability to have them displayed on a high-resolution monitor. And so we are
seeing things we've never seen before and the vision is excellent. I'm sure 10
years from now this is going to be standard and everybody's going to have
robotic bronchoscopy. And some people are still wondering you know, where its
applicability really lies, but for us it's allowing us to take the lung back.
Rather than having a CT guided biopsy we're able to get things from you know
natural orifice. So pulmonary nodules can really be
anywhere and sometimes they're actually outside the airway. But sometimes they're
inside the airway now that we actually have real vision and a smaller
bronchoscope that can be driven with precision into these small airways, we
are seeing more things than we've seen before. We are seeing these
nodules that are either in the airway or they're abutting the airway causing a
little bit of an indentation of the airway. We're able to then target our
needle to that indentation so that we know we're in that nodule. We're placing
the target on the CAT scan and then the robotic platform is helping us get to
that target that we've placed based on an individualized patient's CAT scan.
We're actually transposing the navigational system, the robotic system
with the CT scan of that particular patient so the patient's individualized
CT scan is inputted into our planning software for the robotic assisted
bronchoscopy allowing us to go to exactly the targeted airway we need to
go. So it's much like driving upwards from a tree trunk into the tree. We want
to make sure that we are at the target because this is important not only for
diagnosis and tissue acquisition in the detection and treatment planning for
lung cancer, but also in the future it's going to lead the way to tumor or nodule
ablation where maybe somebody isn't a candidate to have surgery and they have
a lung cancer, and we can go right to that nodule and deliver some sort of
therapy to shrink or get rid of the nodule. You have to be very
detail-oriented because the setup is critical because if you think about it,
when you're doing the navigation the robots not telling us where to
go, we're telling the robot where to go and so if our navigation and our targets
are not set correctly, which we do, and if we're not driving correctly, we're not
going to get to the target. Each sample that we take we actually have a
person in the room that is trained in cytology and pathology that will look
at that sample under the microscope to let us know if we're in truly the right
place and then we will continue taking a lot of sample because these days
especially in lung cancer, it is not just about getting a diagnosis anymore. It's
now we need to get more and more tissue to assess molecular characteristics of a
particular tumor type so that immunotherapy or personalized
chemotherapy, those sorts of decisions, can be made based upon the molecular
profiling of a specific tumor. So the benefits to the patient are to hopefully
avoid procedures that are more invasive that they didn't need and ultimately to
not have surgery for something that isn't a cancer that they didn't need
surgery for to diagnose. We are happy to be pioneers and really being on the
forefront of new technology and new technology that we can bring to patients
and really to help improve the detection and diagnosis of lung cancer.