Intraprocedural O-arm computed tomography-guided navigation with ventilatory strategy for atelectasis electromagnetic navigation bronchoscopic biopsy of peripheral lung lesions: an IDEAL stage 2a study.

Background: Electromagnetic navigation bronchoscopy (ENB) is a useful tool for the diagnosis of pulmonary lesions; however, the diagnostic accuracy is usually limited, especially for peripheral pulmonary lesions. To enhance the diagnostic accuracy of ENB for peripheral pulmonary lesions, we developed an innovative modification called intraprocedural computed tomography-guided navigation with ventilatory strategy for atelectasis (ICNVA)-ENB. Methods: In this single-center prospective cohort study [IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) framework stage 2a], we enrolled patients scheduled for ENB-guided pulmonary lesion biopsy. Departing from conventional ENB, navigation planning relied solely on intraoperative O-arm computed tomography (CT) scans acquired after intubation in a hybrid operating room. A standardized ventilation protocol was applied during both CT acquisition and ENB to prevent lung collapse and reduce CT to body divergence (CTBD). There were of 50 consecutive participants were included from March 2022 onward. Iterative technical refinements were documented per IDEAL guidelines, alongside patient demographics and procedural outcomes. Results: All biopsies were successfully completed. Complications included pneumothorax (n=2) and self-limited bleeding (n=2), none requiring intervention. Four technical adjustments were implemented: (I) initial modifications enhanced procedural safety; (II) use of Wang's needle (MW-319) for puncture tunneling significantly improved targeting accuracy; and (III) reduced CT scan area decreased patient radiation exposure. Conclusions: ICNVA-ENB demonstrates promising safety and efficacy for peripheral lung lesion biopsy, with iterative refinements optimizing accuracy and reducing risks.