Robotic-assisted and electromagnetic navigation bronchoscopy for multi-focal lung cancers: a narrative review.

Background and Objective: The incidence of multi-focal lung cancers (MFLCs) has increased with the widespread use of low-dose computed tomography, posing significant diagnostic and therapeutic challenges, particularly in differentiating multiple primary lung cancers from intrapulmonary metastasis. Surgical resection remains the standard treatment for early localized disease; however, it is often unsuitable for patients with multi-focal tumors, lesions near vital structures, or impaired lung function. This review aims to summarize current evidence on the use of minimally invasive bronchoscopic platforms, including robotic-assisted bronchoscopy (RAB) and electromagnetic navigation bronchoscopy (ENB), in the diagnosis and treatment of MFLCs. Methods: A literature search of PubMed, Embase, and Web of Science was performed with a primary search on February 28, 2025 and a final update on September 30, 2025; only English-language publications were included. Keywords included "multi-focal lung cancer", "robotic-assisted bronchoscopy", "electromagnetic navigation bronchoscopy", "bronchoscopic ablation", and related terms. Relevant original studies, clinical trials, case series, reviews, and abstracts were included. Key Content and Findings: RAB and ENB enable precise localization and access to peripheral lung lesions, enabling diagnostic biopsy and bronchoscopic ablation while preserving lung tissue. These approaches are particularly advantageous for patients who are poor surgical candidates, allowing the treatment of multiple lesions in a single session with shorter recovery times. Integration with stereotactic body radiation therapy, immunotherapy, and molecular profiling may further enhance local control and personalize therapy. Conclusions: Bronchoscopic navigation platforms represent a promising addition to multidisciplinary MFLCs management by broadening eligibility for minimally invasive treatment and preserving lung function. With continued refinement and incorporation into multimodal strategies, these technologies may reshape therapeutic algorithms and influence future clinical practice and research direction.