World Expert Consensus Recommendations on Shape-Sensing Robotic-Assisted Bronchoscopy for the Diagnosis of Peripheral Pulmonary Lesions

Shape-sensing robotic-assisted bronchoscopy (ssRAB) represents a major advancement in the bronchoscopic evaluation of pulmonary nodules suspicious for malignancy. Its use has expanded across multiple countries and healthcare systems; however, no global consensus currently exists to guide clinical practice or address areas of uncertainty. This first world expert consensus was developed by an international panel of 18 specialists in interventional pulmonology and ssRAB, representing 13 hospitals across three continents. The process included a systematic literature review, followed by multiple rounds of structured questionnaires, sharing of clinical experience, and informed discussion, in order to identify key domains and establish consensus statements. A total of 38 recommendations were generated across domains including indications and contraindications, procedural set up, practical workflow, anesthesia considerations, diagnostic tools, training, reporting standards, and safety practices of ssRAB. Full consensus (100% agreement) was achieved for all 38 statements following three voting rounds and extensive discussion. This first international expert consensus provides comprehensive, evidence-informed guidance on the clinical use of ssRAB. It also highlights areas of ongoing uncertainty and can serve as a foundation for future research, education, and guideline development in this rapidly evolving field.