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Practical Application of Virtual Bronchoscopic Navigation

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Interventional Bronchoscopy

Part of the book series: Respiratory Medicine ((RM,volume 10))

Abstract

Transbronchial biopsy for peripheral pulmonary lesions (PPLs) is associated with fewer complications than percutaneous biopsy. However, the diagnostic yield using transbronchial biopsy can be inadequate, and depends on the operator’s skill. Virtual bronchoscopic navigation (VBN) is a method in which a bronchoscope is guided using virtual bronchoscopy (VB) images on the bronchial route to a peripheral lesion. A system that allows automatic search for the route to the target, production of VB images, and matched display with real images has been developed. This system is used for diagnosis of peripheral lesions, marker placement for surgery or radiotherapy, and education and training. VBN is used in combination with CT-guided ultrathin bronchoscopy, endobronchial ultrasonography with a guide-sheath (EBUS-GS), and bronchoscopy with or without X-ray fluoroscopy. Based on prospective studies, the diagnostic yield is 74 % for all PPLs and 68 % for lesions ≤2 cm. In a recent randomized study, use of VBN in association with EBUS-GS increased the diagnostic yield for ≤3 cm lesions from 67 to 80 %, and shortened the total examination time. A meta-analysis has also revealed the usefulness of VBN. There are many advantages of VBN. Even beginners can readily use this technique for peripheral lesions, and a high diagnostic rate can be obtained. To increase the diagnostic yield using VBN, it is important to clarify the relationship between the lesion and extracted bronchi, select appropriate bronchoscopic techniques, and combine them with VBN. CT should be performed under appropriate conditions. VBN is a useful method to support bronchoscopy; wider use and further development of this system are expected.

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Abbreviations

EBUS:

Endobronchial ultrasonography

EBUS-GS:

Endobronchial ultrasonography with a guide-sheath

EMN:

Electromagnetic navigation

PPL:

Peripheral pulmonary lesion

VB:

Virtual bronchoscopy

VBN:

Virtual bronchoscopic navigation

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Authors and Affiliations

  1. Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, 4-6-1 Noishiki, Gifu, 5008717, Japan

    Fumihiro Asano M.D., F.C.C.P.

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  1. Fumihiro Asano M.D., F.C.C.P.
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Correspondence to Fumihiro Asano M.D., F.C.C.P. .

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Editors and Affiliations

  1. , Pulmonary, Allergy and Critical Care Med, Cleveland Clinic, Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Atul Mehta

  2. , Pulmonary and Critical Care Medicine, Louis A. Johnson VAMC, Medical Center Drive 1, West Virginia, 26301, USA

    Prasoon Jain

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Asano, F. (2013). Practical Application of Virtual Bronchoscopic Navigation. In: Mehta, A., Jain, P. (eds) Interventional Bronchoscopy. Respiratory Medicine, vol 10. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-395-4_7

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  • DOI: https://doi.org/10.1007/978-1-62703-395-4_7

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