By Ansley Franco
Grandview Medical Center became the first hospital in Birmingham to begin using Intuitive’s Ion endoluminal system, a robotic bronchoscopy platform, that allows physicians to obtain samples from deep within the lung. They are among the few centers in the state to have this technology.
Paired with shape sensing technology, real-time imaging, and fiber-like optics that make thousands of calculations a second, Tyler Wahl, MD, thoracic surgeon at Grandview, said the Ion helps with navigating within millimeters.
“That’s important because if you’re talking about the difference in millimeters, for me to hit a lung nodule, those millimeters in accuracy are pretty much what determines whether you’re getting an answer or getting a nondiagnostic result,” Wahl said.
Since Grandview obtained the Ion in October 2023, Wahl and pulmonologist Russell Beaty, MD have performed 100 cases. Wahl said their biopsy accuracy has jumped from 60 to70 percent to 96 percent since using the Ion.
“The accuracy for sub-centimeter nodules is so much better now with this Ion robotic platform than the prior predecessors. We used to have something that was two centimeters and larger to get a diagnosis with any sort of high percentage marks on the prior platforms that various companies made. But now, the average nodule size is certainly less than two centimeters. My personal average nodule size is 1.3 centimeters,” Wahl said.
Previously, Wahl used one of the several other procedural options when performing a lung biopsy. An example is a percutaneous biopsy, which calls for a physician to guide a needle through the chest under imaging to take a sample of lung tissue. This technique comes with complications such as pneumothorax and pulmonary hemorrhage. Wahl said the Ion’s minimally invasive bronchoscopy has no pain, no recovery and gets to the part of the lung where you have an interest in exploring.
During a procedure with the Ion, the patient goes under general anesthetics, and a breathing tube is put in the airway. After checking the lung with a small light scope, the Ion’s three-millimeter fiber optic camera is placed, and a virtual roadmap on the computer screen will help guide the doctor to the correct airway. Once completed, a radial endobronchial ultrasound will go down to the same catheter to look at the signal of the lung and potentially find something hard, like a nodule. With the help of the ultrasound, a doctor can fine-tune their angles and approach to begin taking a biopsy.
“When we do that, we’re getting a lot more tissue and samples for the pathologist to use because cancer care and receptors on cancers such as immunotherapy is a big topic right now,” Wahl said. “So now we’re able to understand, not just that you have a cancer, we actually can do very personalized medicine by obtaining more tissue, we can run a lot of tests to look for receptor status.”
According to the World Health Organization, lung cancer is the leading cause of cancer-related deaths worldwide, and stage 1 lung cancer can vary from one to three centimeters. With the Ion, healthcare professionals don’t have to leave lung cancer in the body and wait until it grows to biopsy it.
When he was younger, Wahl began considering pursuing a career in the medical field when his grandmother, a non-smoker, was diagnosed with lung cancer. Through his mentorship at UAB, he fell in love with chest oncology. He aims to progress the lung cancer enterprise at Grandview and was excited to hear about the hospital’s recognition as a top facility for the Go To Lung Foundation last year.