THE ION: VOYAGING LUNG PATHWAYS

A robotic-assisted bronchoscopy platform

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and photo by Elisabeth Slay

“It’s pretty different compared to what we’ve used in the past Basically, it’s for patients who have lung nodules that are a concern for lung cancer,” Dr Reinersman said “It allows us to biopsy the nodules when they’re smaller ”

He explained it’s often difficult to biopsy these nodules as they’re in challenging areas to operate on or too small to accurately biopsy forcing surgeons to wait until the nodules increase in size

“We were limited to having radiologist biopsy the nodules from the outside where they put the patients in a CAT scan and put a needle in the patient from the outside and that can be successful if the nodule is on the outside of the lung but if it’s deeper there’s a higher risk of complications,” he said

These complications include bleeding or hemothorax which is when there is air outside of the lung in between the lung and the chest wall “The risk of that happening with the Ion, because we do it through the inside of the lung, is much lower and we’re able to do the biopsy and potentially stage their lymphoid,” Dr Reinersman said

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Staging is when a pathologist determines if cells are cancerous and biopsies allow the surgeons to determine how far the disease has spread in the body if the cells are positive.

By utilizing the Ion, Dr Reinersman explained pathologists have the ability to give him “real-time results” and then the surgical team can “use a different scope and look at a” patient’s lymph nodes, and “potentially get the diagnosis and the staging in one anesthesia ”

Essentially the Ion is a rolling cart with numerous screens and a control panel attached to an arm that connects to a patient’s body through a treaclier tube. The arm is magnetically connected to the treaclier tube and there is a camera attached to another arm that navigates through the patient’s body The camera is controlled by a portable panel connected to the system

“What we do is we get a CAT scan of the patient and we load that into a special computer and we generate a map of the inside of their lungs to the nodule,” Reinersman said. “It’s basically a GPS roadmap and the Ion creates a plan of which pathway to go down to get to the nodule inside the lungs.”

When a clear path is determined, Dr Reinrsman explained the map appears on the screens of the Ion as a three-dimensional image of the patient’s lung and the nodule “We used to do an electromagnetic navigational biopsy which would generate a magnetic field and you’d have to have the operating room mapped out a certain way,” he said.

This technique was useful for certain nodules but made it difficult to resect a nodule if it was deep within the lung “In that case, you’d have to remove the whole lobe which would be problematic especially if it turns out it’s not cancerous,” he said Dr Reinersman explained the Ion was acquired about two years ago.

The electromagnetic navigational biopsy only had a 65 percent success rate.

"We’d be taking these patients to determine through a biopsy if they had lung cancer and it was frustrating because you could determine it more than half the time but that’s not enough and we were putting people through potentially unnecessary procedures.”

The Ion is more precise and efficient than an electromagnetic navigational biopsy. The technology is just so fascinating with the Ion because the way the other ones worked is that you were limited on a standard bronchoscope,” he explained.

“A standard bronchoscope isn’t very long and it’s big, so it can only go about a third of the way into the airway So, then these systems would give you a roadmap but you’d only see so much, and then you’d have to hope you were going down the right pathway to the nodule.”

With the Ion, Dr. Reinersman explained he has better access to a visual of the lung and the pathway to the nodule

“The camera is under robotic control so you can drive it all the way to the edge of the lung,” he stated. “So, it’s really a huge revolutionary step forward in navigating inside the lung and getting to pathology.”

To learn how to use the Ion, Dr Reinersman said one should already have knowledge of performing bronchoscopies.

“For the most part here at OU we have it so that the only persons that can get credentialed to use it are those who’ve completed a thoracic surgery fellowship or have completed an interventional pulmonary fellowship,” he said “So, you need a lot of extra training and Intuitive sends you to a special course.”

In this course, trainees learn how the machine works and then perform practice procedures on pigs. In total, there are about 30 hours of extra training to learn how to use the Ion.

“It surprises me how far you’re able to get out into the very edge of the lung,” he said. “And just how powerful it is to be able to get anywhere in the lung and be able to biopsy something that is less than a millimeter in size.”

Dr. Reinersman is amazed at how much access the Ion gives to a patient’s lung and the detailed images of any nodule no matter the size.

“My hope is that it will allow us to be on the forefront of innovation when it comes to lung cancer and allow us to be recognized nationally or internationally as a center that is involved in these advances early,” he said “It’s unique for surgeons to do this ”