Innovation


any single technological component of the procedure.


Consent must be layered. Patients agree to


bronchoscopy, to possible immediate resection, to the option of stopping at biopsy if a benign diagnosis is made, and to the implications of a non-diagnostic biopsy. Selection criteria should be defined at programme level and reviewed prospectively for every case. Data capture is what protects the service in the longer term. The strongest arguments for single-anaesthetic pathways - shorter time to treatment, lower benign resection rate, and lower cost of care - all rest on prospective registries. Units adopting the approach should register cases in a structured database from the outset.


Conclusion Single-anaesthetic Ion-guided robotic navigational bronchoscopy followed by Da Vinci Xi robotic lung resection is a feasible, safe, and clinically attractive option for selected patients with small, hard-to-reach pulmonary nodules. The international evidence supports its ability to shorten the time from diagnosis to treatment, reduce benign resection rates, lower cost of care, and preserve more lung parenchyma than staged pathways. The case described at HCA Healthcare UK’s London Bridge Hospital, to our knowledge the first in the UK independent sector, shows that the operational and technical components are now in place to deliver this pathway routinely in a UK setting. The next steps are programme-level data capture, broader multidisciplinary adoption, and an honest evaluation of where, in the lung nodule pathway, single-anaesthetic management adds the most value for patients.


Acknowledgements The authors thank Nabih Berjaoui from Guy’s and St Thomas’ NHS Foundation Trust for their assistance in preparing this article. All clinical work described was undertaken by the listed authors, who retain full responsibility for its content.


References 1. Kalchiem-Dekel O, Connolly JG, Lin IH, Husta BC, Adusumilli PS, Beattie JA, et al. Shape-sensing robotic-assisted bronchoscopy in the diagnosis


of pulmonary parenchymal lesions. Chest. 2022;161(2):572–82. https://pubmed.ncbi.nlm. nih.gov/34370981/


2. Patel A, Zollinger B, Suzuki K, Patel PP. Robotic- assisted lung nodule diagnosis and resection. Front Oncol. 2025;15:1555151. https://pmc.ncbi. nlm.nih.gov/articles/PMC11968345/


3. Akhmerov A, Brownlee A, Soukiasian H, Watson JJ, Chen Q, Soukiasian SG, et al. Combining robotic navigational bronchoscopy and lung resection under a single anesthesia (SABR). Ann Thorac Surg Short Reports. 2024. https:// pmc.ncbi.nlm.nih.gov/articles/PMC12167518/


4. Perez C, Weiser L, Yu W, Knabe K, Soukiasian SG, Rocco R, et al. Combined robotic bronchoscopic biopsy with surgical resection during the same anesthetic event. JTCVS Tech. 2025. https:// pmc.ncbi.nlm.nih.gov/articles/PMC12529668/


5. Ramsuchit B, MacDonald N, Johnston M, Escalon J, Herrera L. Efficacy of single-anesthesia bronchoscopy and resection using the shape-sensing robotic navigational platform. Innovations (Phila). 2025. https://journals. sagepub.com/doi/10.1177/15569845251344598


6. Guarize J, Bertolaccini L, Spaggiari L. Fast track pathway for lung cancer: the integration of Ion robotic-assisted bronchoscopy with robotic thoracic surgical resection. Surg Innov. 2025. https://journals.sagepub.com/ doi/10.1177/15533506251375786


7. Wolf A, Miller P, Burk J, Vigness R, Hollingsworth J. Ability of single anesthesia for combined robotic-assisted bronchoscopy and surgical lobectomy to reduce time between detection and treatment in stage I non-small cell lung cancer. Proc (Bayl Univ Med Cent). 2023;36(4):459–63. https://www.tandfonline. com/doi/full/10.1080/08998280.2023.2193134


CSJ


8. Santis G, et al, Prospective evaluation of Robotic Navigation Bronchoscopy in the diagnosis and management of low-risk lung nodules, Lung Cancer, Accessed at: https://doi. org/10.1016/j.lungcan.2026.109020


Further reading: 9. Menghesha H, Arensmeyer JC, Feodorovici P, Coburn M, Skowasch D, Kuetting D, et al. Double-lumen intubation facilitating a single-anesthesia workflow in robot-assisted navigational bronchoscopy and subsequent lung resection. J Clin Med. 2026;15(3):1025. https://www.mdpi.com/2077-0383/15/3/1025 10. Swenson K, Ayasa L, De Angelis P, Parikh M,


Single-anaesthetic Ion-guided robotic navigational bronchoscopy followed by Da Vinci Xi robotic lung resection is a feasible, safe, and clinically attractive option.


28 www.clinicalservicesjournal.com I October 2026


Beattie J, Majid A, et al. Single-anesthetic bronchoscopic biopsy to robotic resection workflow. JTCVS Tech. 2025. https://pmc.ncbi. nlm.nih.gov/articles/PMC12881792/


11. Ross P, Skabla P, Ross L, Meyer TJ. Single-port robotic lung resection: Ion bronchoscopy and SP robot under single episode of anesthesia. Chest. 2025;168(4 Suppl). https://linkinghub. elsevier.com/retrieve/pii/S0012369225010104


About the authors


Mr Andrea Bille is a Consultant Thoracic Surgeon at Guy’s and St Thomas’ NHS Foundation Trust and a Professor at King’s College London, specialising in minimally


invasive and robotic surgery for a broad range of thoracic conditions, including lung cancer, mesothelioma, pneumothorax, pleural disease, and mediastinal tumours. Trained in Turin and London, he has held senior roles in both the UK and Italy, including at the National Institute of Cancer in Milan, and completed advanced fellowships at Guy’s Hospital and Memorial Sloan Kettering Cancer Centre. He combines clinical expertise with a strong academic focus on thoracic oncology and mesothelioma, has published over 80 scientific papers, and is actively involved in international research, staging committees, and professional societies within thoracic surgery.


Professor George Santis is a highly experienced Consultant Physician in Respiratory Medicine at Guy’s & St Thomas’ NHS Foundation Trust, where he has worked for


nearly three decades, and Professor of Thoracic Oncology and Interventional Bronchoscopy at King’s College London. He specialises in the management of complex lung conditions, including lung cancer and treatment-related complications such as interstitial lung disease. A pioneer in interventional respiratory techniques, he was among the first in the UK to establish Endobronchial Ultrasound (EBUS) and is now leading advancements in Ion robotic navigation bronchoscopy in Europe, combining this with EBUS to streamline diagnosis and staging. Alongside his clinical work, he has held numerous research and leadership roles and remains focused on advancing innovative technologies to improve patient care.


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