New robotic diagnostic device searches for lung cancer

DULUTH -- A new technology platform at Essentia Health-St. Mary's Medical Center in Duluth can help diagnose more cases of cancerous nodules in lungs than was previously possible. Essentia on Sept. 30 began using the Monarch Platform, a robotic bronchoscope with a camera at the end, to perform hard-to-reach biopsies in patients' lungs.

Essentia pulmonologist Eric Swanson said the technology is a game-changer for collecting biopsies from the outer bronchioles in lungs. Previous technology did not have a camera or controllable direction, which made sample collection somewhat of a gamble, he said.

“It’s a big, big upgrade from what we had before,” Swanson said. “(Before), you’d just pass a small catheter through a regular bronchoscope and you turn it and hope you land in the right spot.”

Patients who have a computed tomography (CT) scan that shows a nodule, or abnormal growth in the lungs, will then get a biopsy taken from the nodule to check for cancer. However, Swanson said about 80% of lung nodules are found on the far edges of the lungs, which were harder to reach before the use of the Monarch Platform.

"It’s the patients that you couldn’t do before where the benefit is here,” said Brady Peterson, a representative from vendor Auris Health.

The Monarch Platform is an endoscope guided by a handheld controller very similar to an Xbox controller. As the Monarch Platform drives through the lungs, the camera and other diagrams on a screen help the physician locate the nodule, then collect the biopsy with better accuracy and precision. Swanson, who said he used to play Xbox games, finds the control extremely intuitive.

Peterson said the Monarch Platform is an artificial intelligence system that navigates with 3D models of the patients' lungs, then uploads each case to a cloud.

More than 90% of people diagnosed with lung cancer do not survive, partly because it frequently isn't diagnosed until it is in advanced stages. Lung cancer screenings are recommended for people age 50-80 with the equivalent of 20 years of pack-a-day smoking, according to the U.S. Preventive Services Task Force. These guidelines were changed in March to include more smokers and former smokers. Screenings are especially encouraged now since November is Lung Cancer Awareness Month, and cancer screenings have greatly declined since the start of the coronavirus pandemic.

The 15 operations performed with the Monarch Platform at Essentia between Sept. 30 and Nov. 1 were all successful, Swanson said, and at least one patient was someone he would not have attempted to operate on with the old technology.

"If we were using the old one and we couldn’t get a piece of (the nodule), we would ask a radiologist to possibly do a CT-guided biopsy — which gives them a 20% chance of collapsing their lung — or we’d ask a surgeon to cut something out, which is a five-day stay in the hospital,” Swanson said.

With the Monarch Platform, patients are put under general anesthesia during the minimally invasive procedure and released from care the same day. The Monarch Platform was cleared by the U.S. Food and Drug Administration in 2018.

Swanson and Andrew Keenan are the only physicians trained to use the technology, but more doctors will be trained as needed. Swanson said they've already increased the number of days for procedures as they reach more patients. The machine in Duluth is the first one in northern Minnesota, northern Wisconsin and the Upper Peninsula of Michigan. Essentia also has a Monarch Platform at its Fargo campus.

The American Cancer Society estimates that more than 235,000 people will be diagnosed with lung cancer in 2021, and nearly 132,000 people will die of the disease. Lung cancer has the highest mortality rate of all cancers, killing more people than breast, colorectal and prostate cancers combined. Smoking is the leading cause of lung cancer.