Ion Robotic Bronchoscopy-Guided Microwave Ablation Under Augmented Fluoroscopy: An Initial Case Series and Comparative Procedural Workflow Analysis.

PURPOSE: Bronchoscopic microwave ablation (MWA) is an emerging therapy for peripheral pulmonary lesions. Clinical cohorts evaluating the Ion robotic-assisted bronchoscopy (RAB) system for MWA remain lacking. We report our initial prospective experience with Ion RAB-guided MWA using an augmented fluoroscopy (AF) workflow, benchmarked against a historical electromagnetic navigation bronchoscopy (ENB) cohort. MATERIALS AND METHODS: This prospective single-center cohort study evaluated 21 consecutive patients prospectively enrolled to undergo microwave ablation (MWA) for peripheral pulmonary lesions using the Ion RAB system (25 lesions) between January 1, 2025, and January 1, 2026, and benchmarked these outcomes against a retrospectively established historical cohort of 42 consecutive ENB-guided MWA procedures (51 lesions) performed at the same center under an augmented fluoroscopy (AF) strategy. The primary endpoint was postoperative day 1 (POD1) technical success. Secondary endpoints included 6-month treatment success, navigation/total workflow times, cone-beam CT (CBCT) acquisitions, radiation dose, and complications. RESULTS: POD1 technical success was 100% (21/21) for RAB and 92.9% (39/42) for ENB (p = 0.545). At 6 months, treatment success was 100% (21/21) vs. 90.5% (38/42), respectively (p = 0.292). Benchmarked against ENB, RAB significantly reduced median navigation time (2 vs 28.5 min, p < 0.001), total workflow time (75 vs 128 min, p < 0.001), and CBCT acquisitions (2 vs 4, p < 0.001). Consequently, median radiation dose was significantly lower for RAB (118 vs 215 mGy, p < 0.001). Complication rates were 4.8% and 7.1%. CONCLUSION: Ion RAB-guided MWA under AF is feasible and safe. This RAB workflow ensures precise ablation while offering superior efficiency and substantially reducing patient radiation exposure.