Successful resection of multi-focal lung nodules in a 53-year-old male following preoperative 5G-assisted remote robotic bronchoscopy dye marking: a case report

Background: Robotic-assisted bronchoscopy is an effective platform for transbronchial localization of pulmonary nodules before sublobar resection. However, access to this specialized technology and expertise is often limited to tertiary centers, creating geographic disparities in care. This case report describes the first clinical application of fifth-generation (5G)-assisted remote robotic bronchoscopy for preoperative dye marking, aiming to address this gap in surgical access and resource distribution.

Case Description: A 53-year-old asymptomatic male with two persistent ground-glass nodules [14 mm in the right upper lobe (RUL) and 7 mm in the right lower lobe (RLL)] was scheduled for resection. His medical history was unremarkable. Preoperative localization was performed using an artificial intelligence-enhanced robotic bronchoscopy system (Polaris^TM). The surgeon, operating from a remote console, successfully navigated to both lesions and injected indocyanine green at each site, with stable network latency of 21–24 milliseconds. Subsequent uniportal video-assisted thoracic surgery (VATS) wedge resection, guided by fluorescence imaging, was completed within 30 minutes with negligible estimated blood loss. Final pathology confirmed that the nodule in the RUL was atypical adenomatous hyperplasia (AAH), while that in the RLL was predominantly bronchiolar adenoma with a focal 2-mm non-mucinous adenocarcinoma in situ (AIS) component. The patient had an uneventful recovery and was discharged on postoperative day (POD) three.

Conclusions: This initial case suggests the technical feasibility of 5G remote-controlled robotic bronchoscopy for preoperative localization. The ultra-low latency 5G network ensured real-time and precise control. This approach potentially expands access to specialized thoracic surgical expertise across geographical barriers. Its broader safety, efficacy, and clinical utility require validation in larger, prospective studies.