{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:56:38Z","timestamp":1793505398743,"version":"4.5.0"},"reference-count":74,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Conventional electromagnetic navigation bronchoscopy and other guided bronchoscopic modalities have a very desirable safety profile, but their diagnostic yield is only 60\u201370% for pulmonary lesions. Recently, robotic-assisted bronchoscopy (RAB) platforms have been introduced to improve the diagnostic performance of bronchoscopic modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the diagnostic performance and safety profile of RAB (using shape-sensing and electromagnetic navigation\u2013based platforms) by performing a systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PubMed, Embase, and Google Scholar databases were searched to find studies that reported on the diagnostic performance and\/or the safety profile of one of the RAB systems. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was performed using MedCalc version 20.118. Pooled diagnostic yield was calculated using a Freeman-Tukey transformation. We planned to use a random-effects model if the I \u00a02 index was &amp;gt;40%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-five studies were included: 20 including diagnostic and safety analyses and 5 including only safety analyses. The pooled diagnostic yield of RAB (20 studies, 1,779 lesions) was 84.3% (95% confidence interval, 81.1\u201387.2%). The I \u00a02 index was 65.6%. On the basis of our subgroup analyses, the heterogeneity was likely driven by differences in study designs (prospective vs. retrospective) and procedural protocols (such as different RAB systems). Lesion size\u2009&amp;gt;\u20092\u2009cm, the presence of a computed tomography bronchus sign, and concentric radial endobronchial ultrasound view were associated with a statistically significant increase in the odds of diagnosis with RAB. The overall rates of pneumothorax, need for tube thoracostomy, and significant hemorrhage were 2.3%, 1.2%, and 0.5%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RAB systems have significantly increased the diagnostic yield of navigational bronchoscopy compared with conventional systems such as electromagnetic navigation bronchoscopy, but well-designed prospective studies are needed to better understand the impact of various factors, such as the use of three-dimensional imaging modalities, cryobiopsy, and specific ventilatory protocols, on the diagnostic yield of RAB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.202301-075oc","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T15:15:30Z","timestamp":1695914130000},"page":"1801-1812","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":92,"title":["Diagnostic Performance and Safety Profile of Robotic-assisted Bronchoscopy: A Systematic Review and Meta-Analysis"],"prefix":"10.1093","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9343-1074","authenticated-orcid":false,"given":"Muhammad Sajawal","family":"Ali","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine"},{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uzair Khan","family":"Ghori","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7751-6505","authenticated-orcid":false,"given":"Max Theodore","family":"Wayne","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Shostak","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"De Cardenas","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"2026012203295004900_bib1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1258\/jms.2011.011055","article-title":"Lung cancer screening with low-dose helical CT: results from the National Lung Screening Trial (NLST)","volume":"18","author":"Kramer","year":"2011","journal-title":"J Med Screen"},{"key":"2026012203295004900_bib2","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1164\/rccm.201505-0990OC","article-title":"Recent trends in the identification of incidental pulmonary nodules","volume":"192","author":"Gould","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012203295004900_bib3","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1148\/radiol.2017161659","article-title":"Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017","volume":"284","author":"MacMahon","year":"2017","journal-title":"Radiology"},{"key":"2026012203295004900_bib4","doi-asserted-by":"crossref","first-page":"e93S","DOI":"10.1378\/chest.12-2351","article-title":"Evaluation of individuals with pulmonary nodules: when is it lung cancer? 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