Innovation


Pioneering advances in robotic bronchoscopy


HCA Healthcare UK’s London Bridge Hospital has carried out what is believed to be the first single-anaesthetic, Ion-guided robotic navigational bronchoscopy followed immediately by robotic lung resection. George Santis and Andrea Bille provide an insight.


Most early-stage lung cancers present as small, sometimes sub-centimetre nodules on screening CT scans or as incidental findings on CT chest scans, performed for unrelated reasons. This has created new challenges in how best to diagnose and manage early lung cancers in a timely and efficient diagnostic and treatment pathway. In April 2026, at HCA Healthcare UK’s London Bridge Hospital, we carried out what we believe to be the first single-anaesthetic, Ion-guided robotic navigational bronchoscopy followed immediately by Da Vinci Xi robotic lung resection performed in the UK independent sector. This article describes that case, places it in the context of the wider international literature on single- anaesthetic biopsy-to-resection pathways, and reflects on what is needed, operationally, to deliver this kind of service safely and at scale.


A changing problem Lung cancer is still the leading cause of cancer death in the UK, and outcome remains tightly bound to stage at diagnosis. Lung cancer screening, together with the steady rise in CT use for other indications, has produced a corresponding rise in incidental pulmonary nodules. Before the routine availability of robotic


assisted navigation bronchoscopy, up to 20% of patients in our experience proceeded to surgery without a tissue diagnosis. That increased the number of purely diagnostic surgical procedures and reduced overall service efficiency. Conventional management has otherwise split the patient journey into two episodes of anaesthesia. Diagnosis is obtained by bronchoscopy, endobronchial ultrasound (EBUS) or percutaneous biopsy. Definitive treatment follows at a later date by video-assisted or robotic-assisted thoracoscopic surgery. The interval between the two is rarely shorter than two or three weeks. For the patient, it is a period of uncertainty during which there is a small but real risk of further growth of the lesion. Two technologies have changed what is


ION navigation screen to localise the lesion


possible. Shape-sensing robotic-assisted bronchoscopy with the Ion™ Endoluminal System (Intuitive Surgical, Sunnyvale, CA) uses a 3.5 mm fully articulating catheter and fibre-optic shape sensing to reach lesions in any of the 18 bronchopulmonary segments with sub-millimetre positional feedback.1


In parallel, robotic thoracic


surgery on the Da Vinci platform has made anatomical sublobar resection a reproducible, lung-sparing alternative to lobectomy in selected early-stage cancers.2


Combining the two under a single anaesthetic,


when clinically indicated, allows the lesion to be biopsied or marked and resected in the same operating session. The diagnostic-to-therapeutic interval collapses to zero, and the same anaesthetic, intubation, and operating team are used throughout. Internationally the approach has been described


under several names: SABR (single-anaesthetic bronchoscopy and resection),3


SABRR (single-


anaesthetic robotic bronchoscopy, biopsy and resection),4


SABAR,5 and, in European fast-track


protocols, an integrated Ion-to-robotic-surgery pathway.6


The principle behind each is the same.


Case presentation A patient in their seventh decade was referred with two synchronous pulmonary nodules identified on a staging CT performed for an unrelated indication. The first was peripheral and solid, amenable to anatomical segmental resection on its CT coordinates alone. The second was a small, non-solid ground-glass nodule in the contralateral lung. It sat deep to the visceral pleura and was not palpable from the pleural surface. Both lesions were radiologically suspicious for primary lung malignancy. A PET-CT showed no avid mediastinal or distant disease, and pulmonary function was preserved. After multidisciplinary review, the patient was selected for combined, single-anaesthetic Ion- guided localisation and robotic resection. Pre-procedure planning used a 1 mm slice volumetric CT loaded into the Ion planning software. A navigation pathway was generated from the carina to within 2 mm of the centre of the ground-glass nodule. This allowed the operator to rehearse the route, identify the nearest accessory bronchus, and anticipate sharp


October 2026 I www.clinicalservicesjournal.com 25


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