Robotic-Assisted Bronchoscopy with Integrated Cone-Beam Computed Tomography under Sedation: A Proof-of-Concept Case Series

Background Robotic-assisted bronchoscopy with integrated cone-beam computed tomography (RAB+CBCT) is currently approved only for use under general anaesthesia. Procedural sedation and analgesia (PSA) administered by pulmonologists is safe and routinely used for cardiopulmonary fit patients. This case series evaluates the feasibility and safety of RAB+CBCT performed under PSA by pulmonologists. Methods Robotic-assisted bronchoscopy (Ion endoluminal system, Intuitive) with integrated cone-beam computed tomography (Cios Spin, Siemens Healthineers) was performed using PSA and endotracheal intubation. Procedures were conducted by one experienced pulmonologist (>200 RAB+CBCT cases), assisted by two experienced bronchoscopy nurses. Sedation was achieved via target-controlled infusion of 1% propofol and topical lidocaine. Vital parameters were continuously monitored throughout the procedure, with as needed norepinephrine. Results Two cardiopulmonary-healthy males and one female patient (26 – 41 yrs) underwent successful RAB+CBCT. A total of four lesions with a mean axis of 9 – 13 mm were biopsied. Lesions were located in the left upper lobe (2), left lower lobe (1) and right upper lobe (1), respectively. Procedure times were 12 – 20 minutes. One minor endobronchial bleed (Nashville grade 2) occurred. Conclusion This case series provides a proof-of concept for performing RAB+CBCT under sedation in cardiopulmonary-healthy patients and is part of a larger 30 patient pilot study (NCT07006311). Fig. 1 Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany