Next-gen robotic bronchoscopy for lung cancer diagnosis reveals promising results

MedTech News: A world-first clinical trial of robotic technology that allows doctors to access tiny nodules in the farthest reaches of the lungs is already showing promising results. It could prove to be a game changer in the early detection of lung cancer.

Medical robotics innovator Noah Medical unveiled their trial at Macquarie University Hospital in Sydney. The FRONTIER study is a first in human trial focused on the safety and feasibility of the Galaxy System, which is designed to improve location accuracy and successful diagnosis of lung nodules using its proprietary TiLT+ Technology. 

More than 9,000 people die of lung cancer per year in Australia. It’s the nation’s biggest cancer killer and around 42% of lung cancer diagnoses occur at stage 4, leading to poor survival rates.

The new robotics option makes the process less distressing for those patients who might otherwise have to either wait for the nodule to grow or choose to have surgery that could prove to be unnecessary.
Professor Alvin Ing, one of Australia’s leading interventional pulmonolgists, is chief investigator in the clinical trial.

“Traditionally, biopsies of lung nodules have been performed via a needle through the chest wall and into the lung, but this carries the risk of significant complications, with the possibility that it could cause the lung to collapse or resulting in bleeding that can be very hard to control,” said Professor Ing.

“A standard bronchoscopy is also an option, but in cases where the nodule is very small and deep in the lung, where the airways are narrowest, it can be difficult to reach and hard to accurately sample, so it tends to result in a successful diagnosis in fewer than 70% of cases. This new option makes the process much less distressing for those patients who might otherwise have to either wait for the nodule to grow or choose to have surgery that could prove to be unnecessary,” he added.

The Galaxy system uses data from CT scans of the patient’s lungs to create a highly detailed GPS‑style map to the nodule. During the procedure, a probe is inserted into the airway, and with the assistance of the robotic arm, the doctor uses an Xbox-style controller to follow the map straight to the nodule. Sweeps from a C-arm X-ray machine confirm in real time that the probe is correctly placed, and the robotic arm holds it steady while samples are collected.

Countries such as the UK, US, Canada, France and Germany have established routine lung screening programs to provide regular scans for people at high risk of lung cancer.

The Australian government is considering establishing a national lung cancer screening program after the advice from Medical Services Advisory Committee (MSAC) in October 2022, similar to the programs already in place for breast, bowel and cervical cancer. If such a program were to be established, then small nodules would be discovered earlier and more accurate sampling methods, such as robotically assisted bronchoscopies, would be in high demand.

But robotically assisted bronchoscopy is not the answer in every case, and they should not be performed without proper consideration from a multidisciplinary team. Macquarie University Hospital’s MQ Health Respiratory and Sleep Clinic established a pulmonary nodule clinic last year, with a team that includes interventional pulmonologists like Professor Ing and Associate Professor Tajalli Saghaie, who work with cardiothoracic surgeons, radiologists and oncologists.

“Some patients will go straight to surgery because the mass in their lung is growing quickly, with other tests suggesting lung cancer, while others will need radiotherapy because they are too frail for general anaesthetic and surgery,” noted Professor Ing.

Jian Zhang, PhD, Noah Medical founder and CEO, said “This is the first study to validate the Galaxy System’s core value propositions within a clinical environment, and we look forward to continuing to build the clinical evidence for the Galaxy System.”

Prior to Noah Medical, Jian co-founded two other successful startups and served as the CEO. Previously he was an employee at Auris Health which was acquired by Johnson & Johnson for $5.7B in 2019. Prior to joining Auris, he worked in engineering at Intuitive Surgical. 

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