A case series of nonintubated robotic-assisted bronchoscopy: a feasible alternative to intubated techniques.

Background: Robotic-assisted bronchoscopy (RAB) is widely used for pulmonary lesion management but is limited by its requirement for endotracheal intubation. In recent years, non-intubated anesthesia had emerged as an available alternative for thoracic procedure. Integrating RAB with a nonintubated approach may overcome current limitations, expand patient eligibility, and simplify procedural logistics. This study aims to evaluate the safety and feasibility of non-intubated RAB. Case Description: There were seven patients with 10 lesions underwent nonintubated RAB using the Monarch system. All procedures were successfully performed, with an average lesion size of 1.4 cm and a mean procedure time of 33.8 minutes. Pathology concordance was 100%, with 100% navigation accuracy. No intraoperative or postoperative complications occurred. Among them, five patients with positive diagnosis proceeded directly to thoracoscopic surgery under a single anesthetic regimen, avoiding the need for transitioning from single-lumen to double-lumen intubation. The mean interval between biopsy and resection was only 24.2 minutes, and recovery was rapid, with a mean postoperative recovery time of 26.7 minutes. Conclusions: Nonintubated RAB offers a safe, efficient, and flexible alternative to traditional intubated approach, particularly for patients with narrow airways or significant airway obstruction. By eliminating the need for inhalational anesthesia, this approach also aligns with sustainable practices.