For years, robotic bronchoscopy was confined mainly to elite academic centers and referral hospitals that possessed the budgets, staffing, and infrastructure required to support early-generation systems. That era is ending. Today, second-generation robotic platforms, smarter imaging, and more flexible economics are enabling community hospitals to deliver cutting-edge lung-cancer diagnostics to patients who once had to travel for hours to receive the same care.
I have seen firsthand how new surgical robotic platforms empower smaller systems to deliver superior outcomes while growing financially sustainable offerings, proving that innovation doesn’t just belong to large institutions. With a focus on access, the right technology, and creative execution, community hospitals can deliver advanced care while strengthening their bottom lines.
From early experiments to everyday practice
When launching a robotic bronchoscopy (RB) program, the goal should be simple: improve diagnostic accuracy for peripheral lung lesions while minimizing procedural burden. My initial approach combined navigation technology with advanced imaging support and produced meaningful clinical improvements. However, limitations quickly became apparent, including challenges with visualization, constrained instrument maneuverability, and workflow complexity that slowed broader adoption.
The real turning point for RB programs came when the robotic platforms began integrating advanced imaging. This combination delivered what earlier attempts at the technology could not: continuous visualization, a simplified workflow, and consistent device performance through a single-use bronchoscope..
Just as important, this innovation in RB was accomplished without adding cost or complexity to the operating room. Integrated imaging meant no additional investment into other imaging systems (like Cone Beam CTCBCT), lower radiation exposure, and faster turnover times. These practical advantages are critical in community settings, where staff bandwidth and room utilization directly affect viability.
Imaging integration: The true differentiator
Early multicenter research highlighted an important lesson: first-generation robotic systems that lack integrated imaging capabilities tend to deliver only modest diagnostic performance when evaluated rigorously. In contrast, coupling robotics with advanced fluoroscopy (AF) or C-arm-based tomography dramatically improves outcomes.
This real-time visualization is a clinical equalizer because it allows physicians to navigate precisely and adjust trajectories dynamically, capabilities that make the difference between sampling the right nodule and missing it. And, the “always-on” vision of integrated imaging provides confidence even with small, ground-glass lesions close to the hilum, where older systems struggled.
For community hospitals, this integration also means efficiency. Combining visualization and navigation into a single platform eliminates redundant equipment and reduces capital expenditure. It turns what once required an operating room packed with hardware into a clean, compact workflow that fits comfortably within an endoscopy suite. That shift alone can accelerate adoption across mid-sized facilities nationwide.
The economics of access
Clinical success is only part of the story. For robotics to truly democratize care, it must also make financial sense for hospitals with tight margins. That’s where the latest generation of systems stands apart.
Robotic bronchoscopy teams should evaluate new technology using key metrics, including contribution margin, cost-benefit ratio (CBA), return on investment (ROI), and payback period. Using these measures, a robotic bronchoscopy program can prove not only clinically sound but also economically sustainable.
Finally, community hospitals should consider one creative change to flip the economics: moving robotic bronchoscopy from the OR to the endoscopy suite or minor operating rooms and leveraging complexity-adjusted Ambulatory Payment Classifications (APCs), 31628 + 31629 + 31653. In my experience, , this shift can lift cost-benefit analysis (CBA),, shorten the payback period, and boost contribution margins per case. Critically, single-use design also eliminates reprocessing time and costs, while improving scope reliability, turning a previously break-even program into a consistently profitable, high-performing service line.
At community hospitals the economics can translate into measurable clinical impact. As diagnostic confidence improves, referrals from lung screening and other CT scans increase, driving higher biopsy volumes and earlier-stage detection. This shift toward earlier diagnoses, can not only strengthen oncology referrals but also improve survival outcomes for patients.
A broader definition of equity
More than just cost, democratizing access is also about geography, workforce, and equity. In many rural and semi-urban regions, patients delay evaluation because advanced diagnostics are unavailable locally. By deploying robotic bronchoscopy in community hospitals, we can shorten that distance both literally and figuratively.
Patients can now undergo minimally invasive procedures closer to home, surrounded by their families and support systems. Physicians gain access to the same technological precision as their peers at major centers, without the logistical or financial barriers that historically limited them. In this way, surgical robotics becomes a tool for health equity, not just a means of technological advancement.
For providers, democratization also means empowerment. The ergonomics and intuitive interface of these new systems, what I like to call “a PlayStation controller for the OR,” lower the learning curve and make adoption feasible even in smaller programs. When the tools are accessible and consistent, clinicians can focus on patient care rather than troubleshooting equipment.
The road ahead
As robotic systems grow more integrated, portable, and affordable, community hospitals will need to continue to play a leading role in redefining access to innovation.
Comprehensive robotic bronchoscopy represents the next phase of this evolution, transforming the technology from a standalone diagnostic tool into an integrated lung cancer care platform. By unifying peripheral nodule biopsy with systematic mediastinal staging during a single anesthetic encounter, robotic bronchoscopy enables complete anatomic and pathologic assessment upfront, reducing diagnostic delays and eliminating fragmented, multi-step workflows.
The long-term vision is a single-session, patient-centered pathway in which robotic bronchoscopy, mediastinal staging, and, when appropriate, immediate surgical resection occur within the same operative setting. This model prioritizes efficiency, oncologic rigor, and patient experience while aligning advanced diagnostics with real-time multidisciplinary and surgical decision-making. In doing so, community-based programs can deliver truly end-to-end lung cancer care without sacrificing quality, access, or sustainability.
The convergence of technology and economics is unlocking a new paradigm in which precision care is no longer confined to a few flagship centers. Instead, it is distributed across a national network of hospitals, each capable of offering the same level of diagnostic sophistication at a fraction of the cost.
In that sense, the story of robotic bronchoscopy mirrors the story of medicine itself: innovation advancing not for the few, but for the many. When we democratize access, we not only expand access to technology but also expand the very reach of modern healthcare.
Photo: Mohammed Haneefa Nizamudeen, Getty Images
Dr. Roshen Mathew is the director of interventional pulmonary services at WVU Camden Clark Medical Center. He is one of the only two interventional pulmonologists in the state of West Virginia. He has undergone a specialized fellowship for this and has years of experience in this field. He is board certified by the American Association for Bronchology and Interventional Pulmonology (AABIP) and is involved in research and innovations with this field.
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