Virtual Bronchoscopic Navigation( VBN) and Electromagnetic Navigation System

Recently small peripheral lesions have been discovered due to development of computed tomography (CT) instruments and dissemination of CT examination etc. Histological or cytological diagnosis for peripheral lesions is recommended to be performed. The diagnostic yield for peripheral pulmonary lesion depends on the size. Transbronchial lung biopsy (TBLB) was developed using techniques such as navigation system( vitual bronchoscopic navigation:VBN), endobronchial ultrasonography(EBUS) using guide sheath(GS), extremely small bronchoscope and the like for lesions of 2.0 cm or less. VBN is a method in which virtual bronchoscopy images of the bronchial path to the peripheral lesion are produced and used as a guide to navigate the bronchoscope. In the randomized controlled trial, it was reported that VBN not only improves the diagnostic rate but also shortens the total examination time. The American College of Chest Physician (ACCP) guidelines recommend the use of EBUS-GS, VBN for the bronchoscopic diagnosis of peripheral pulmonary lesions. Bronchial navigation method using a magnetic field (electromagnetic navigation:EMN) to link the navigation system and the actual bronchoscope in real time has appeared. This new technique, electromagnetic navigational bronchoscopy (ENB) promises accurate navigation to peripheral pulmonary target lesion. Bronchoscopic navigation is also used for marking in thoracoscopic surgery, and it is greatly expected not only as a tool for simply diagnosing but also as a treatment technique in the future.