What is navigational bronchoscopy?
Navigational bronchoscopy is a minimally invasive approach for accessing difficult to reach areas of the left or right lung. It is also known as ENB or Electromagnetic Navigation Bronchoscopy. By using the CT scan of your chest as a blueprint, a specialised LungGPS™ technology, not unlike the car GPS, creates a roadmap of your lungs. That roadmap guides your surgeon through the airways of your lungs to the area containing the lung abnormality (nodule) to obtain tissue. A lung nodule is a mass of abnormal tissue that can either be benign (non-cancerous) or malignant (cancerous). The tissue obtained during this procedure can be used for diagnosis, staging of cancer disease and preparation for treatment, if necessary.
Why might I need to have a navigational bronchoscopy?
Reasons for needing this procedure include abnormal findings on a chest x-ray or a CT scan, such as identifying a spot on the lung. Navigational bronchoscopy enables your surgeon to take tissue samples from very small lung nodules in a much safer way than through other methods, and thus potentially detecting lung cancer earlier.
What is expected to happen during navigational bronchoscopy?
Navigational bronchoscopy uses brand-new technology, and it is performed in only a few thoracic surgical centres in the UK by specially trained teams. Navigational bronchoscopy is carried out under general anaesthesia which means that you will be asleep during the procedure.
It may take between 30-60 minutes for the procedure to be completed. The surgeon will insert a flexible bronchoscope through your mouth and into your lungs. Once the tip of the scope is in place, your surgeon will insert special tools to examine your lung and obtain biopsies.
In some cases, the surgeon may need to place very small markers near the lung nodule (no bigger than a grain of rice each) made from gold or other metals. These markers will help guide your medical team when delivering follow-up treatment, for example, stereotactic radiotherapy. The markers can be seen on chest X-ray and can be used as a tracking device. You will not feel them, they are not magnetic, and they do not have to be removed at a later stage.
How does navigational bronchoscopy differ from other biopsy procedures?
During a traditional bronchoscopy, a thin flexible tube (about the width of a pencil) with a light on the end called a bronchoscope is passed through your nose or down the back of your throat to reach your lung airways. During traditional bronchoscopy, however, your doctor can reach only the central areas of the lung airways. With navigational bronchoscopy, your surgeon can navigate to reach nodules even in the most distant areas of the lung by using a minimally invasive approach. Other biopsy options include more invasive techniques such as needle biopsy or surgery, but these carry a higher risk of complications and may not be suitable.
What is the step-by-step guide to navigational bronchoscopy?
- First, your CT scan will be converted into a 3D roadmap of your lungs and loaded onto a computer. Your surgeon will then use this roadmap to guide a bronchoscope to the lung lesion.
- Your surgeon will know the location of the bronchoscope in real time with the help of tracking sensors on your chest and a location board under your back.
- Without making an incision, your surgeon will take tissue samples of the lung nodule for testing and / or place small markers near the lung nodule if follow-up treatment will be necessary.
- After the procedure is completed, you will have a chest X-ray which the surgeons will review.
What are the risks?
Prior to signing your consent form, you will meet your surgeon to discuss the risks and complications of this procedure. Navigational bronchoscopy is associated with a low risk of complications. The most common is pneumothorax (collapsed lung) which occurs in less than 3% of the cases. If this happens, your surgeon will treat it quickly, often by inserting a special chest drain.
What can I expect after the procedure?
The tissue samples taken during the procedure will be sent to the laboratory for testing and histopathological analysis. Your follow-up will take place a few weeks later when your surgeon will contact you with the results and to discuss the next steps for you.
You will be discharged home a few hours after the procedure or on the following day. You will need somebody to collect you from the hospital, therefore please make the necessary arrangements ahead of time. After the general anaesthesia, you may experience nausea, some voice hoarseness or throat discomfort. You may have a small cough and your secretions may be stained with tiny spots of blood. All these symptoms should resolve within a few days. If they persist, or if you develop a temperature or shortness of breath, please call the specialist nurses. You are advised to avoid drinking beverages that are too hot. If required, you can take over-the-counter painkillers. You may return to work within a few days, depending on how you feel and the type of job you do. The nurses will advise you further during your pre-assessment.
Further information
For more information and advice about your thoracic procedure, your hospital stay, the thoracic team and our enhanced recovery programme, please see our Thoracic Surgery Patient Information Page and Patient Diary. You can get in touch by calling us on 0203 456 6047 or by emailing us at uclh.
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Page last updated: 18 September 2025
Review due: 01 September 2027