Virtual Bronchoscopic Navigation

Virtual Bronchoscopic Navigation System
Over the years, lung nodules are detected more frequently with the advancements in imaging techniques and the increasing availability of this technology. These nodules are sometimes benign tumors, but sometimes they are malignant tumors.


 When such a nodule is detected, it can sometimes be very difficult for physicians to make a decision. Deciding between recommending an unnecessary surgical intervention to the patient or delaying the surgical treatment of an early detected malignant tumor is possible by taking many factors into consideration. Although various diagnostic tools (sequential CT and PET/CT) are used in diagnosis and follow-up, bronchoscopy is mostly performed for definitive diagnosis. Bronchoscopy is a diagnostic procedure in which the airways are examined from the inside under direct vision. With this method, the detected nodule is reached and a biopsy is taken from there. This procedure has been widely and successfully applied for approximately 40 years.

However, for this procedure to be successful, the nodule detected by imaging methods must be in an accessible area within the airways. Airways are a natural pathway that branches from the trachea and decreases in diameter until it reaches the lung tissue. 

Although biopsy can be easily taken from the nodules that can be seen in this path (Figure 2), as the number of branches increases, it is not possible to reach the nodule and naturally biopsy cannot be taken.

In the virtual bronchoscopic navigation system, the nodule detected on computer tomography is loaded into the system as the target to be reached. (Picture 1) When the bronchoscopy process begins, both the real image and the virtual image appear on the screen together. (Picture 2) As bronchial branching increases, the person performing the procedure approaches the target by following the shortest and most convenient path shown to him in the virtual image. Even if the target is not visible in the real image, it moves to the nearest point that can be reached thanks to the virtual navigation system. Then, a biopsy is taken with the help of special needles.

Picture 1
Picture 2 (The screen on the right is the real image, the screen on the left is the virtual image and navigation)
The diagnostic value of bronchoscopy obtained with this method has increased significantly. It has been used successfully in various centers in the USA and Europe for about 10 years. The procedure takes 10-15 minutes longer than the standard procedure. The complication rate is negligibly low. The benefit obtained is largely a guide for more appropriate selection of subsequent treatment methods.


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