"Think of a large oak tree with a huge trunk and hundreds of branches," said Ramsy Abdelghani, MD, director of Tulane's Interventional Pulmonology Program, "and I'm being guided to one specific leaf."
That's how he describes the capabilities of Tulane's state-of-the-art Robotic Bronchoscopy Program, which combines a robotic bronchoscope with real-time advanced cone beam CT scan imaging, allowing him to precisely navigate to virtually anywhere within the lungs and biopsy smaller lesions than ever before. This leads to earlier diagnoses of lung cancer, essential for good outcomes. Tulane has performed more of these advanced procedures than any other program in the state.
The robot utilizes a pre-procedural CT scan to precisely isolate the location of the nodule and create a suggested route for the bronchoscope — GPS-like directions that allow Dr. Abdelghani to guide a thin, 360-degree maneuverable catheter through the numerous airways that make up the lungs directly to his target. And some of these nodules are as small as 3.5 mm in diameter — approximately three times smaller than those he could biopsy previously.
"I use a console to drive the robot, almost like a video game," said Abdelghani. "Without guidance, this would be extremely challenging. These airways all look the same and there are hundreds of wrong turns I could make along the way."
Once the target is reached, a low-dose CT scan allows Dr. Abdelghani to see the spatial relationship of the catheter to the nodule, make adjustments if necessary and then biopsy with confidence that he's in the correct position to retrieve a good tissue sample. "If the pathology comes back benign, I can say with relative certainty that I got a good representation of the lesion," said Abdelghani. "The way I think about it is the robot gets me to the driveway, but the cone beam CT scan gets me to the front door."
All Tulane Medical Center patients with lung nodules are now referred to Dr. Abdelghani's clinic. Previously, small lung nodules that incidentally showed up on imaging tests of the heart or abdomen may not have been candidates for biopsy because they were too small. "But since the availability of robotic bronchoscopy, I haven't said no yet," said Abdelghani, who has biopsied approximately 250 nodules in the year since the program started.
Robotic bronchoscopy requires general anesthesia. However, the potential risks of this scarless, well-tolerated, virtually pain-free procedure are quite low, and Dr. Abdelghani says most patients go home the same day.
If you are interested in learning more or making an appointment with one of Tulane's board-certified interventional pulmonologists, please contact Dr. Abdelghani at firstname.lastname@example.org or call Tulane's Lung Nodule Clinic at 504-988-8600.