Robotic bronchoscopy for diagnosis of lung nodules using the Ion system: a narrative review of the technical aspects and advantages over standard flexible bronchoscopy with electromagnetic navigation

Background and Objective: With the increasing volumes of computed tomography (CT) done in daily practice, there is an ever-increasing role for diagnostic bronchoscopy in sampling peripheral lung nodules. The past twenty years have led to significant advances in electromagnetic navigation systems and are dominated by the superDimension™ system (Medtronic, Minneapolis, MN, USA) and the Veran® SPiN system (Veran Medical Technologies, St. Louis, MO, USA). Their yield in available studies is as low as 33% when used without other localization systems. In 2019, two robotic systems were approved: the Monarch® (Auris Health, Redwood City, CA, USA) which utilizes electromagnetic navigation and the Ion™ (Intuitive Medical, Sunnyvale, CA, USA) which uses shape-sensing technology. When comparing the Ion™ to traditional electromagnetic navigation there are many advantages including small catheter (i.e., bronchoscope) size, ability to lock catheter in place, and integration with other localization systems. While preliminary data is suggestive of an improved yield, data remains limited. This review will provide a brief history of bronchoscopy using electromagnetic navigation and discuss the differences when compared to the Ion™ robotic bronchoscope.