Electromagnetic navigation during flexible bronchoscopy.
BACKGROUND
Flexible bronchoscopy is routinely utilized in the diagnosis and treatment of various lung diseases. Nondiagnostic bronchoscopy leads to more invasive interventions, such as transthoracic needle aspiration, mediastinoscopy or even thoracotomy. Electromagnetic navigation is a novel technology that facilitates approaching peripheral lung lesions, which are difficult to sample by conventional means. The navigation system involves creating an electromagnetic field around the chest and localizing an endoscopic tool using a microsensor overlaid upon previously acquired CT images.


OBJECTIVE
To determine the practicality, accuracy and safety of real-time electromagnetic navigation, coupled with previously acquired 3D CT images, in locating artificially created peripheral lung lesions in a swine model.


METHODS
Peripheral lung lesions were created in four swine models by insertion of a metal tube (1 x 10 mm) via a transthoracic approach. An electromagnetic field was created by placing the animal on an electromagnetic location board. A position sensor incorporated into the distal tip of a dedicated tool was used to navigate to the various target lesions. Information gathered in real time during bronchoscopy was presented on a monitor simultaneously by displaying previously acquired CT images. Upon reaching the target lesion, biopsies were performed and the functionality and safety of the superDimension/Bronchus System was observed and documented.


RESULTS
The registration accuracy expressed by the fiducial target registration error, expressing both the registration quality and the stability of fiducial (registration) points, was 4.5 mm on average. No adverse effects, such as pneumothorax or internal bleeding, were encountered in any of the animals in this study.


CONCLUSIONS
Real-time electromagnetic positioning technology coupled with previously acquired CT images is an accurate technology added to standard bronchoscopy to assist in reaching peripheral lung lesions and performing biopsies.
Schwarz
Yehuda
Y
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. Schwarz@tasmc.health.gov.il
Mehta
Atul C
AC
Ernst
Armin
A
Herth
Felix
F
Engel
Ahuva
A
Besser
Doron
D
Becker
Heinrich D
HD
D000818:Animals; D001999:Bronchoscopy / Q000379:methods*; D004574:Electromagnetic Fields; D055590:Electromagnetic Phenomena; D005260:Female; D023421:Models, Animal; D025321:Surgery, Computer-Assisted; D013552:Swine