The role of electromagnetic navigational bronchoscopy in the era of robotics

The advent of the superDimension (Medtronic Corporation, Minneapolis, MN, USA) electromagnetic navigation bronchoscopy (ENB) offers bronchoscopists specialized navigation software to create a 3-dimensional map to target peripheral pulmonary nodules. A pervasive criticism of ENB has centered around the reliance on virtual targets and catheter deflection. The presence of CT-to-body divergence is a critical concern when attempting to ensure that the virtual target truly represents the target lesion. Attempts to make up for the shortcomings of ENB have resulted in development of multiple robotic bronchoscopic platforms. Robotically guided bronchoscopy platforms typically feature smaller scopes that are used to navigate through the small, peripheral airways using automated arms. The ability to successfully biopsy peripheral lung nodules will continue to improve as both the ENB platforms and robotic bronchoscopy platforms evolve. A central question to the future of biopsy platforms is whether one is preferred over the other.