Abstract
BACKGROUND: Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a novel technology with demonstrated safety and high diagnostic yield in the evaluation of pulmonary nodules. When combined with robotic-assisted thoracic surgery, ssRAB enables a single-anesthesia strategy for both biopsy and definitive resection. METHODS: This technical report describes a reproducible workflow for performing robotic bronchoscopy followed by pulmonary resection under a single anesthetic. A novel aspect of this approach is the use of a double-lumen endotracheal tube and lateral decubitus positioning from the outset, allowing uninterrupted transition between diagnostic bronchoscopy, dye marking, and anatomical resection. Step-by-step details of room setup, airway management, bronchoscopic navigation, dye injection, and anatomic resection are provided. RESULTS: The technique was performed successfully in all described cases with minimal intraoperative complications. Dye localization was accurate in each instance, facilitating rapid identification of target lesions during resection. The total additional operative time attributable to ssRAB and dye marking was minimal. Postoperative recovery was uneventful. CONCLUSIONS: This streamlined technique offers a safe and efficient method for diagnosing and treating early-stage lung cancer in a single operative setting. Lateral positioning with a double-lumen tube facilitates workflow efficiency and may serve as a model for other institutions seeking to implement single-anesthetic bronchoscopic resection pathways.