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Original Research: INTERVENTIONAL PULMONOLOGY |

A Virtual Bronchoscopic Navigation System for Pulmonary Peripheral Lesions*

Fumihiro Asano, MD, PhD; Yoshihiko Matsuno, MD; Naofumi Shinagawa, MD; Koichi Yamazaki, MD, PhD; Toshitaka Suzuki, MD; Takashi Ishida, MD, PhD; Hiroshi Moriya, MD, PhD
Author and Funding Information

*From the Department of Respiratory Medicine (Drs. Asano and Matsuno), Gifu Prefectural Gifu Hospital, Gifu; the First Department of Medicine (Drs. Shinagawa and Yamazaki), Hokkaido University School of Medicine, Sapporo; the Departments of Internal Medicine (Dr. Suzuki), National Health Insurance Sekigahara Hospital, Gifu; the Department of Respiratory Medicine (Dr. Ishida), Fukushima Medical University School of Medicine, Fukushima; and the Department of Radiology (Dr. Moriya), Ohara General Hospital, Fukushima, Japan.

Correspondence to: Fumihiro Asano, MD, PhD, Department of Respiratory Medicine, Gifu Prefectural Gifu Hospital, 4-6-1 Noishiki, Gifu 500-8717, Japan; e-mail: asano-fm@ceres.ocn.ne.jp



Chest. 2006;130(2):559-566. doi:10.1378/chest.130.2.559
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Study objectives: We performed ultrathin bronchoscopy for pulmonary peripheral lesions using a system that displays virtual bronchoscopy (VB) images to the lesion simultaneously with actual images and navigates the bronchoscope to the target bronchus. We then evaluated the system with regard to its usefulness and problems.

Design: A pilot study.

Setting: A tertiary teaching hospital.

Patients: The subjects were consecutive patients with small pulmonary peripheral lesions (≤ 30 mm).

Interventions: Using this system, the rotation, advancement, and retreat of VB images were possible, and the bronchus into which the bronchoscope was to be advanced was displayed. VB images were displayed along with actual images, and the ultrathin bronchoscope was advanced to the target bronchus under direct vision. Under CT and radiographic fluoroscopy, a pair of forceps was inserted into the lesion via the bronchoscope. Thin-section CT images were obtained; after confirming the advancement of the bronchoscope into the target bronchus and the arrival of the forceps at the lesion, a biopsy was performed.

Results: Study subjects included 37 patients with 38 lesions. VB images to a median of the sixth- (third- to ninth-) order bronchi could be produced. Using this system, the ultrathin bronchoscope could be advanced into the planned route for 36 of the 38 lesions (94.7%). The system was used for a median of 2.6 min, and the median examination time was 24.9 min. The biopsy forceps could be advanced to the lesion in 33 of the 38 lesions (86.8%), and diagnosis was possible for 31 lesions (81.6%).

Conclusions: This navigation system is useful for ultrathin bronchoscopy for pulmonary peripheral lesions.

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