How Ion Works | Robotic-Assisted Bronchoscopy

Discover the technology

See the workflow that supports you from planning to completing a peripheral lung nodule biopsy. The journey begins with Ion’s tools that allow you to plan and navigate your path to the nodule. As your guided catheter approaches the nodule, you can confirm tool-in-lesion accuracy with integrated 3D imaging.

When you’re ready, Ion allows you to park the catheter in place to perform the biopsy. Because Ion doesn’t rely on electromagnetic navigation, the system integrates into bronchoscopy suites and ORs without metal or ferromagnetic interference affecting the magnetic field.

Plan your procedure

Your experience with Ion begins with PACS (picture archiving and communication system) and our PlanPoint software. PlanPoint’s integration with PACS allows for secure and efficient retrieval of CT scans over the hospital network or directly from applicable imaging modalities.

From the patient CT scan, PlanPoint generates 3D airway trees and automatically creates a path and anatomy borders once a target is identified. Through the PlanPoint interface, you can review, edit, and finalize your plan to be used as guidance during the procedure.

Navigate to the target

During the bronchoscopy, use Ion’s controller to navigate to the target along your pre-planned path. With Ion’s ultrathin robotic catheter and advanced maneuverability,¹ you can navigate far into the peripheral lung.

The catheter, which has a 3.5 mm outer diameter and a 2.0 mm working channel, can articulate 180° in any direction and pass around tight turns, allowing it to reach all 18 segments of the lung.² In addition, Ion’s fiber-optic shape sensor measures the full shape of the catheter, providing real-time precise location and shape information throughout navigation and biopsy.

Ion virtual and live camera views with compass directions

With Ion’s vision probe, you have real-time vision of the airway while navigating to the target. The camera provides a 120° field of view for navigation and a sharp videoscopic image for anatomy identification.

During navigation, you can synchronize the virtual and the live camera views. And Ion’s compass feature translates the direction of the catheter to anatomical directions on the screen in real time. The compass provides you with additional navigation guidance and enables easier catheter articulation.³

Ion software showing targeted lung nodule location

Confirm the target

Ion's software includes several tools to help you navigate to the target, which can be important if you encounter a difference in the nodule location seen in static preprocedural CTs and intraprocedural imaging (CT-to-body divergence). When using radial EBUS, Ion provides guidance to streamline target identification. When using external cone-beam CT (CBCT) imaging, Ion can mark the current catheter position in the 3D biopsy view.

When using integrated Cios Spin mobile imaging, Ion receives 3D images from Cios Spin on demand during the procedure. This allows you to update target locations and helps you make precise⁴ catheter adjustments based on the provided intraprocedural 3D images. In preclinical testing, Ion integration with Cios Spin enabled tool-in-lesion accuracy of 100% in an average of 1.41 spins.²

Biopsy the lesion

Once the pulmonary nodule is reached, you can lock the catheter in place. A combination of the shape sensor’s real-time measurements with robotic control algorithms allows the catheter to hold its position.

Ion’s Flexision Needle was custom designed to pass through the catheter, even when positioned in tortuous airways. After advancing around tight-radius bends, the needle deploys into the target location on a straight path.

During biopsy, Ion’s biopsy marker feature lets you systematically track multiple biopsy attempts, and helps you visualize different biopsy needle trajectories. If real-time confirmation of a representative tissue sample is available, you can redirect subsequent biopsy attempts into the confirmed target area. This approach is referred to as cloud biopsy.⁵

Integration and connectivity

Ion system in a suite integrated with Cios Spin

Technology integration

Ion is designed to fit easily into a bronchoscopy suite and integrate with existing technologies. Physical proximity has been taken into account with a design that keeps you close to the patient’s airways throughout the procedure.

Although Ion does not require the use of CBCT for nodule biopsy, we designed the system to be compatible with external CBCT and provide integrated connectivity with Cios Spin mobile imaging. Ion integration with Cios Spin is designed to be seamless, allowing system components to be positioned without physical interference. Ion also leverages existing imaging technologies with radial endobronchial ultrasound (rEBUS), fluoroscopic, virtual, and live views of the airways unified in a single system.

Instruments and accessories

ION FULLY ARTICULATING CATHETER

The catheter has a 3.5 mm outer diameter with 2 mm working channel and articulates 180° in any direction.

ION PERIPHERAL VISION PROBE

The vision probe fits within the tool channel of the Ion fully articulating catheter and provides a 120° field of view.

FLEXISION BIOPSY NEEDLE

The biopsy needle, available in 19G, 21G, and 23G, can extend up to 3 cm and is protected by a flexible retractable sheath, with a stylet for support during insertion.

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Comparisons of precision, reach, and stability are relative to manual techniques. Comparisons of flexibility and maneuverability are relative to ENB technology. Precision is the ability to place a biopsy tool in the desired location consistently. Flexibility is the ability to articulate 180° in all directions. Reach is defined by airway generation access. Stability is enabled by fiber optic sensing technology which maintains active robotic control of catheter position and corrects unwanted tip deflection. Results based on internal testing. Data on file at Intuitive.
Data on file at Intuitive.
Compared to the previous software version.
Precise is defined as ability to place catheter tip, and therefore biopsy tools, in specific and desired positions due to maneuverability of the catheter.
Cloud biopsy is Intuitive’s terminology for describing Ion’s ability to enable users to systematically perform biopsy attempts and redirect subsequent biopsy attempts into a target area if real-time confirmation of a representative tissue sample is available during a procedure.

Disclosures and important safety information

Important safety information

Risks associated with bronchoscopy through an endotracheal tube and under general anesthesia are infrequent and typically minor, and may include but are not limited to: sore throat, hoarseness, respiratory complications including dyspnea or hypoxemia, airway injury, bronchospasm, laryngospasm, fever, hemoptysis, chest or lung infection including pneumonia, lung abscess or an adverse reaction to anesthesia. Although rare, the following complications may also occur: bleeding, pneumothorax (collapsed lung), cardiac related complications, respiratory failure, air embolism, or death. As with other medical procedures, there may be additional risks associated with the use of general anesthesia and/or endotracheal intubation which are not listed above; you should consult a health care professional regarding these and other potential risks.

Procedures using the Ion Endoluminal System may be associated with longer procedure and/or longer anesthesia time.

Individuals’ outcomes may depend on a number of factors—including but not limited to—patient characteristics, disease characteristics, and/or physician experience.

Ion endoluminal system

The Ion Endoluminal System (Model IF1000) assists the user in navigating a catheter and endoscopic tools in the pulmonary tract using endoscopic visualization of the tracheobronchial tree for diagnostic and therapeutic procedures. The Ion Endoluminal System enables fiducial marker placement. It does not make a diagnosis and is not for pediatric use.

The Flexision Biopsy Needle is used with the Ion Endoluminal System to biopsy tissue from a target area in the lung.

The PlanPoint Software uses patient CT scans to create a 3D plan of the lung and navigation pathways for use with the Ion Endoluminal System.