# Double-Lumen Intubation Facilitating a Single-Anesthesia Workflow in Robot-Assisted Navigational Bronchoscopy and Subsequent Lung Resection: A Single-Center, Retrospective Study

## TL;DR

Using a double-lumen tube during robotic bronchoscopy improves diagnostic accuracy and allows same-day lung nodule diagnosis and treatment.

## Contribution

This study introduces a streamlined workflow using double-lumen intubation to improve efficiency and diagnostic yield in robotic bronchoscopy and lung resection.

## Key findings

- Double-lumen tube placement significantly increased diagnostic yield compared to single-lumen tube.
- No major complications were observed in the integrated robotic bronchoscopy and lung resection workflow.
- The average RNB procedure time was 58.3 minutes with a 73% overall diagnostic yield.

## Abstract

Background: Robotic-assisted navigational bronchoscopy (RNB) using the ION system (Intuitive Surgical, Sunnyvale, CA, USA) combined with cone-beam computed tomography (CBCT) (Cios Spin, Siemens Healthineers, Erlangen, Germany) and tool-in-lesion verification enables precise diagnosis of peripheral pulmonary nodules. Integrating RNB with intraoperative frozen section analysis may allow same-day resection, avoiding delays between diagnosis and treatment. Standard airway management with a single-lumen tube (SLT) limits immediate transition to lung resection, whereas initial double-lumen tube (DLT) placement could streamline workflow and improve safety. This study evaluated the diagnostic performance, procedural efficiency, and feasibility of an integrated ION-guided RNB workflow using either SLT or DLT. Methods: In this single-center retrospective study, 36 consecutive patients undergoing ION-guided RNB for pulmonary nodules between August 2024 and June 2025 were analyzed. Airway management (SLT vs. DLT) was selected based on surgical planning. Lesions were targeted using CBCT or C-arm fluoroscopy, and biopsies were performed via forceps or cryoprobes. Frozen section results guided immediate surgical resection when malignancy was confirmed. Results: Thirty-six patients (mean age 64.9 ± 7.9 years; female/male ratio 16/20) with 42 nodules (mean diameter 1.22 ± 0.76 cm) were included; 76.2% were peripheral. Mean RNB time was 58.3 ± 21.3 min. Overall diagnostic yield was 73.0%, significantly higher with DLT versus SLT (84.2% vs. 50.0%, p = 0.035), with more biopsies per patient (7.9 ± 2.2 vs. 3.2 ± 3.1, p = 0.035). No major complications occurred. Conclusions: ION-guided RNB with CBCT and intraoperative frozen section enables accurate, single-session diagnosis and treatment of pulmonary nodules. Upfront DLT placement facilitates procedural efficiency within a streamlined “one-stop-shop” workflow without compromising diagnostic yield.