Robotic Bronchoscopy Enables Single-Session Lung Cancer Diagnosis and Staging

Screening programs detect an estimated 1.6 million suspicious lung nodules each year in the U.S., yet most prove benign while a critical minority are malignant and lethal when diagnosed late. Clinicians need accurate tissue diagnosis and staging with fewer complications and repeat procedures. A newly reported multicenter study suggests that shape-sensing robotic-assisted bronchoscopy can streamline diagnosis and staging of peripheral pulmonary lesions. Researchers have now detailed performance and stage distribution after adopting this approach across three sites.

Shape-sensing robotic-assisted bronchoscopy (ssRAB), implemented at Mayo Clinic and cleared by the Food and Drug Administration (FDA) in 2019, stabilizes navigation to peripheral targets and enables multiple biopsies to secure adequate tissue for diagnosis and molecular testing. The platform can be paired with endobronchial ultrasound (EBUS) to stage mediastinal lymph nodes during the same session. When used with real-time three-dimensional imaging or cone-beam computed tomography (CT), operators can confirm tool-in-lesion positioning before sampling.

In a five-year multisite study published in 2026 in Mayo Clinic Proceedings, investigators evaluated 2,115 lung lesions in 1,904 patients across Mayo Clinic campuses in Jacksonville, Phoenix, and Rochester from 2019 to 2024. Using newly standardized national criteria, the study reported 85% sensitivity for malignancy and 76.9% strict diagnostic yield, with a 2.8% complication rate. The analysis applied updated strict diagnostic yield definitions from the American Thoracic Society (ATS) and American College of Chest Physicians (ACCP).

The stage distribution of diagnosed cancers shifted after adoption. Early-stage diagnoses at Mayo Clinic increased from 46% in 2019 to nearly 69% by mid-2024, while advanced-stage diagnoses decreased from 54% to 31% in 2024. Of sampled lesions, 56% were malignant, 21% were definitively benign, and 23% were nondiagnostic under strict criteria.

Robotic bronchoscopy platforms are increasingly combined with endobronchial therapies, including pulsed electric field ablation for patients ineligible for surgery or radiation. Mayo Clinic has begun offering diagnosis, staging, and treatment during a single procedure. Five-year survival for localized lung cancer approaches 67% compared with approximately 12% for metastatic disease, and national guidelines call for timely evaluation and treatment as screening expands and demand for precise, minimally invasive diagnostics grows.

“Lung cancer survival depends heavily on early detection. Technologies that allow us to diagnose and even treat disease earlier—and with fewer complications—can help improve survival,” said Sebastian Fernandez-Bussy, M.D., James C. and Sarah K. Kennedy Dean of Research and pulmonary and critical care physician, Mayo Clinic in Florida.

“I call this the ‘single anesthetic lung surgery pathway,’ and it means fewer trips to the hospital, less time away from family and shorter recovery times,” said Janani Reisenauer, M.D., chair of thoracic surgery, Mayo Clinic in Rochester, Minnesota.

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