A Randomized Trial Comparing a Ventilatory Strategy To Prevent Atelectasis Versus a Lateral Decubitus Strategy During Robotic Bronchoscopy (VESPA vs. LADS Trial)

Primary Objective:

To compare the proportion of patients developing target-obscuring atelectasis when using a lateral decubitus strategy (LADS) vs using a ventilatory strategy to prevent atelectasis (VESPA) during robotic bronchoscopy for posteriorly-located peripheral lung lesions.

Secondary Objectives:

• To compare the proportion of patients with atelectasis in the target lobe in VESPA vs. LADS during robotic bronchoscopy.
• To compare the proportion of patients with atelectasis obscuring 100%, 50% or more, and less than 50% of the target during robotic bronchoscopy using LADS vs. VESPA.
• To compare the proportion of patients in whom a biopsy sample was not taken due to atelectasis using LADS vs. VESPA.
• To compare the diagnostic yield using LADS vs. VESPA.
• To compare the proportion of tool in lesion (TIL) using LADS vs. VESPA.
• To compare the diagnostic accuracy (sensitivity and specificity) for malignancy using LADS vs. VESPA.
• To compare the proportion of LADS-induced vs. VESPA-induced complications.
• To compare the proportion of bronchoscopy-induced complications in LADS vs. VESPA.
• To compare the accuracy of 3D-2D image registration using LADS vs. VESPA.
• To compare clinical workflow in robotic bronchoscopy with VESPA and LADS strategies to identify potential improvements in workflow.

Inclusion criteria

• Adult patients (≥ 18 years old) undergoing diagnostic robotic bronchoscopy for a lung nodule suspicious for malignancy bronchoscopy under general anesthesia.
• Lung nodules should be up to 3 cm in diameter and located in right or left bronchial segments B2, B6, B9, and B10. Greater than 50% of the volume of the lesion needs to be below a horizontal line traced at the most anterior edge of the corresponding vertebral body.
• Chest CT performed < 45 days prior to bronchoscopy.
• Voluntary informed consent to participate in the study.

Exclusion criteria

• Patients with prior lung consolidation, interstitial changes or lung masses (> 3 cm in diameter) as seen on most recent CT
• Lesions outside of the designated lung areas defined as inclusion criteria.
• Known pregnancy
• Vulnerable population
• Ascites
• Known diaphragmatic paralysis
• Smokers or ex-smokers with known or suspected severe air-trapping defined as residual volume > 150% of predicted
• History of primary or secondary spontaneous pneumothorax
• Lung bullae > 5 cm
• Patients with mediastinal or hilar adenopathy with high suspicion for malignancy in whom lymph node sampling is indicated and should occur prior to robotic bronchoscopy of the peripheral lesion.
• Patient with active COVID pneumonia.