Stabilizing telerobotic endobronchial imaging and interventions in breathing lungs with a helical brace.

Physiological motion in dynamic luminal organs, such as respiration-induced lung displacement, compromises the stability of tool-tissue interaction during telerobotic endoluminal imaging and interventions. However, existing devices for stabilizing the distal end of a catheter or endoscope face critical limitations: Rigid shape-locking mechanisms risk pressure-induced trauma, electrical hazard, and thermal injury, whereas balloon-based designs obstruct luminal patency. Moreover, they lack sufficient adjustable-diameter range for anatomies such as the bronchial tree. In this work, we present a reconfigurable helical brace that overcomes these challenges. Constructed of rotationally stacking tubular modules of asymmetric stiffness, the helical brace achieved up to almost 10 times diameter tunability (3.0 to 29.3 millimeters), enabling adaptive anchoring across diverse bronchial diameters. The established brace in a dynamic bronchus phantom reduced respiration-induced catheter displacement by about 96.0% while preserving more than 97.4% luminal flow conductance. Ex vivo and in vivo bronchial studies confirmed safety under prolonged radial loading, with no notable surface trauma or deep tissue injury observed. We demonstrate a helically braced telerobotic manipulator that can operate with submillimeter control accuracy in dynamic environments, enabling targeted transbronchial needle interventions in live porcine models, including drug delivery, bronchus puncture, and fluid aspiration. In addition, in vivo studies on porcine lungs showed that the brace-aided telerobotic catheter enhances the stability of optical coherence tomography imaging, effectively achieving respiratory motion-free conditions. This patency-preserving brace enhances stabilization without compromising physiological function and safety, ensuring accurate telerobotic operations in dynamic luminal environments.