Robotic Lung biopsy. Why are we still doing manual biopsies

593 Objectives To evaluate the role Robotic guided PET-CT biopsy of lung lesions in terms of histopathological yield and complication rate. Lung biopsies are usually done manually under intermittent CT or CT fluoroscopic guidance. CT guided biopsy of lesions with high necrotic content is unfruitful in most circumstances. PET-CT delineates the necrotic and highly metabolic tissue with good certainty. Robotic systems can enhance surgical and interventional procedures through improved precision, stability, and dexterity. The high precision of registration, planning, and movement of the robotic arm enables an effective biopsy in all cases, with a high accuracy for even relatively small targets. Methods 22 patients with lung masses referred for PET-CECT scan and Robotic guided biopsy in our center were included. The indications were patients with unknown primary with likely primary detected from PET-CT, suspicious lesions identified from PET-CT in a known primary disease and FNAC or CT guided biopsy negative lesions which are high index of suspicion for malignancy. Robotic arm was positioned to target the maximally metabolically active tissue and the needle was inserted though the apparatus provided. After confirming the adequacy of tissue, check scans were performed. Results Tissue yield was 100% (n=22) and histopathological diagnosis rate was 96 %( n=21). Out of the 22 lesions biopsied 36 %( n=8) were benign and 64% (n=14) turned out to be malignant. The complication rates were pneumothorax 4% (n=1) and haemothorax 4% (n=1). The complications rates were very low when compared with manual CT guided biopsies. In sharp contrast to the CT guided manual procedure which requires multiple check CT scans robotic procedures inherently need lesser manipulation by user. Conclusions Robotic assisted PET-CT lung biopsy has lesser complications and better histo-pathological yield. In future it may pave the way for replacing manual biopsies.