Robotic Bronchoscopy: A Less Invasive Way to Biopsy and Treat a Suspicious Lung Nodule

With robotic bronchoscopy, physicians can more safely reach deep into lungs, expanding options for diagnosis and treatment.

It’s something you never want to hear your doctor say: There’s a spot on your lung. That so-called spot is likely a small mass called a lung nodule and, though most lung nodules are not cancerous, it’s natural to worry.

“We understand that an abnormal CT scan or X-ray is where most patient journeys begin, and that can be terrifying,” says Erik Eduardo Folch, MD, an interventional pulmonologist with Keck Medicine of USC. Dr. Folch also treats patients at USC Arcadia Hospital, part of Keck Medicine. “My goal is to simplify the journey for each patient.”

That journey usually begins with a biopsy. Methods for obtaining tissue from the nodule might include surgery; a needle biopsy, where a needle passes through the chest wall; or conventional bronchoscopy, during which a physician guides a small catheter (the size of your phone’s charging cable) through a patient’s mouth or nose and follows the airways to reach the nodule. Because bronchoscopy is less invasive than surgery and a needle biopsy, it decreases the risk of complications. 

Now there’s a new way to conduct a bronchoscopy: using a shape-sensing robotic platform.

Robotic bronchoscopy increases precision

The physicians of Keck Medicine and USC Arcadia Hospital increasingly use shape-sensing robotic bronchoscopy systems to guide the catheter with more precision. Robotic control is helpful because the airway (the trachea) splits and becomes a maze in the chest with many corridors.

“The shape-sensing robotic bronchoscopy guides the catheter using the pathway that air follows, to reach the deepest and furthest corners of your lungs,” Dr. Folch says.

He has been working with this platform for the last seven years as a less invasive way to biopsy suspicious lung nodules. In addition, within the last three years, Keck Medicine teams, including those at USC Arcadia Hospital, have added capabilities to do cone beam CT imaging during the procedure, to diagnose and stage lung cancer in real time. 

“With the robotic platform, we can get further and to places that we couldn’t have reached before,” Dr. Folch says. “Then the CT scan helps us confirm our location when we arrive where we need to be. At that time, we can confidently and safely obtain tissue diagnosis. In the past, this would have required surgery.” 

The procedure typically takes between 30 and 90 minutes and the patient is asleep throughout. In 2025, Keck Medicine physicians performed more robotic bronchoscopies than needle biopsies. 

“Our skilled surgeons and proceduralists can do this as an outpatient procedure, with minimal complications and on relatively short notice or short delay,” Dr. Folch says. “We’re using the latest and best navigation system in the world.”

New treatment options for those who aren’t candidates for surgery

The team is also going beyond diagnosis to use these procedures to expand treatment options in the form of bronchoscopic ablation.

Ablation is local therapy without surgically removing the tumor, Dr. Folch says. “We treat it on the spot. We can use microwave or radiofrequency ablation. We can also inject nanoparticles or medications, or we can freeze it or heat it. We’re developing a variety of treatment tools.” 

Some of those tools have already been available percutaneously (injected through the skin), but being able to deliver them bronchoscopically reduces the chances of complications. 

These treatments open the door to patients with lung tumors who wouldn’t otherwise have options, including those who: 

• Are not candidates for surgery or radiation
• Had surgery or radiation but it wasn’t fully effective 
• Have tumors outside of the chest with a small number of metastases to the lung 
• Have oligoprogressive disease — a state in which some cancer cells are resistant to treatment (even while the majority are responding) 

“We are working with novel therapies that are showing good results in research, and we hope they will be widely used in the next five years,” Dr. Folch says. “These therapies would impact a patient’s chance of survival and improve quality of life.”

The key to the Keck Medicine approach is the close collaboration of interventional pulmonologists, thoracic surgeons and oncologists. 

“We welcome the opportunity to give a second opinion for patients who have been told that the risk is too high,” Dr. Folch says. “We demystify the process, bringing in the right specialists and creating a plan that puts the patient at the center.” 

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Kim Perez

Kim Perez is a writer and editor for Keck Medicine of USC.

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