World’s first robotic-assisted bronchoscopic microwave ablation of lung metastases performed in HK

Thoracic surgeons at the Chinese University of Hong Kong (CUHK) have become the first in the world to perform noninvasive and lung-sparing robotic-assisted bronchoscopic microwave ablation (RBMA) of lung metastases.

Surgical resection is the main treatment modality for lung metastases, but it is associated with surgical access trauma and removal of adjacent healthy lung tissue. “Advanced cancer patients often have multiple lung metastases distributed throughout both lungs, necessitating bilateral lung incisions and removal of multiple wedges of lung tissue. This can significantly affect patients’ lung function, and may even lead to delay in administration of chemotherapy as the patient recovers from surgery,” pointed out Professor Calvin Ng of the Department of Surgery, CUHK.

“We are very excited to have performed the world’s first RBMA of lung metastases in October 2022,” shared Ng. “Combining the benefits of precise airway navigation with robotic bronchoscopy and our world-leading experience in transbronchial microwave ablation of lung tumours, we can now provide a noninvasive treatment option to patients with lung metastases.”

The procedure is performed in a hybrid operating room, using a remote console linked with robotic arms and a bronchoscope to accurately drive the device to the desired location within the lung. Robotic-assisted bronchoscopy enables more accurate and quicker navigation in the complex human airways through optical visualization and airway recognition, electromagnetic positioning, travelled distance as well as directional fine adjustment.

Upon reaching the target, the catheter is positioned within the lesion and emits microwave energy into the cancer tissue. Tumour necrosis can be achieved instantly at a temperature of 60°C. [Transl Lung Cancer Res 2021;10:1608-1622; Indian J Radiol Imaging 2020;30:206-213]

“The advanced robotic mechanism within the bronchoscope also maintains stability during deployment of the microwave ablation catheter, improving the accuracy and efficiency of the ablation procedure,” noted Dr Rainbow Lau of the Department of Surgery, CUHK.

Benefits of noninvasive and lung-sparing RMBA over conventional resection of lung metastases include no surgical wound, no blood loss, minimal or no pain, low complication rates and short hospital stay.

Since October 2022, three patients have been successfully treated with RBMA by the CUHK team, including a 70-year-old male patient with two lung metastases, a 33-year-old female with three lung metastases, and a 56-year-old female with one lung metastasis. After the procedure, two patients experienced no pain, while one patient reported mild chest pain, which resolved with paracetamol. All three patients resumed daily activities 1–2 days after the procedure and did not experience blood loss or other complications.

RBMA is currently being evaluated in a clinical trial with a target enrolment of up to 145 patients with lung metastases worldwide.

According to Ng, RMBA can be a game-changer for treatment of lung metastases, especially bilateral lung metastases, and may be applicable to treatment of primary lung cancer. However, lesion size and location are key factors in patient selection. Lesions should have a maximal diameter of 2.5 cm and not be abutting main stem bronchus or mediastinal structures, to avoid thermal injury to important visceral structures.