🎯 Background & Rationale
Foreign body (FB) aspiration in adults is relatively uncommon and often presents with non-specific symptoms, leading to delayed diagnosis. While conventional flexible and rigid bronchoscopy are standard for central FBs, retrieving peripheral, distal foreign bodies remains a significant technical challenge because standard bronchoscope outer diameters are too large to navigate deep into subsegmental airways. This case report addresses the clinical gap of utilizing robotic-assisted bronchoscopy (RAB) to navigate, visualize, and extract a peripheral metallic foreign body inaccessible by conventional bronchoscopic techniques.
👥 Study Design & Population
Study Type: Case Report.
Clinical Scenario: A 73-year-old male with a history of uveal melanoma and recent dental work (implants, crowns, and drilling three months prior) presented with non-specific right-sided pleuritic chest pain. Imaging confirmed a thin, linear metallic foreign body (subsequently identified as a dental drill measuring 1.9 cm in length) localized to the periphery of the medial basal segment of the right lower lobe.
📈 Methodology & Rigor
Diagnostic and Procedural Workup Quality: The diagnostic workup utilized chest radiography and non-contrast chest CT to accurately localize the peripheral FB. For the procedure, the authors employed virtual airway mapping and CT-assisted navigational guidance using the Intuitive Ion robotic platform. The technical execution integrated robotic catheter navigation, direct endoscopic visualization of the distal airways, 2D fluoroscopic guidance during forceps grasp and withdrawal, and a two-stage retrieval maneuver (releasing the FB in the trachea to re-grasp it longitudinally through the endotracheal tube). Airway inspection was performed post-retrieval to rule out trauma or bleeding.
🔬 Key Findings [or Planned Endpoints]
Definitive Procedural and Clinical Outcome:
- Exact numerical data regarding procedural duration or physiologic parameters were not provided in the available text, but qualitative outcomes were fully detailed.
- The Intuitive Ion robotic platform successfully navigated to the distal right lower lobe medial basal segment.
- Direct visualization ruled out suspected distal granulation tissue or stenosis.
- The foreign body was successfully grasped with 2.0mm flexible forceps and withdrawn. Because the FB was grasped sideways and could not pass longitudinally through the 8.5 mm endotracheal tube, it was safely released in the trachea and retrieved using a flexible bronchoscope.
- Post-procedure chest radiography confirmed complete resolution of the FB with no pneumothorax.
- Pathological examination confirmed the object was a dental drill measuring 1.9 cm long by <0.1–0.15 cm in diameter. The patient tolerated the procedure well and was discharged a few hours post-procedure.
⚖️ Critical Appraisal
Limitations of Generalizability: As a single case report, this publication lacks the statistical power and comparative data of larger cohorts or randomized trials. The success of this technique is heavily reliant on the radio-opaque nature of the foreign body (allowing 2D fluoroscopic tracking), the availability of advanced robotic platforms (Intuitive Ion), and operator expertise. Additionally, the necessity of repositioning the FB within the trachea highlights a technical nuance that must be anticipated when dealing with elongated rigid objects.
💡 The Clinical Bottom Line
For the interventional pulmonologist, this case establishes robotic-assisted bronchoscopy as a viable, highly effective salvage tool for peripheral tracheobronchial foreign bodies that are anatomically inaccessible to conventional flexible or rigid bronchoscopes. Clinicians should consider RAB when dealing with chronic, peripheral, or occult aspirated foreign bodies in distal subsegmental airways, while keeping in mind the need for fluoroscopic guidance and airway management strategies during extraction.