A Randomized Trial Comparing a Ventilatory Strategy to Prevent Atelectasis Versus a Lateral Decubitus Strategy During Robotic Bronchoscopy (VESPA Vs. LADS Trial)

Eligibility Criteria

• 1. Adult patients (≥ 18 years old) undergoing diagnostic robotic bronchoscopy for a lung nodule suspicious for malignancy bronchoscopy under general anesthesia.
• 2. Lung nodules should be up to 3 cm in diameter and located in right or left bronchial segments B2, B6, B9, and B10. Greater than 50% of the volume of the lesion needs to be below a horizontal line traced at the most anterior edge of the corresponding vertebral body.
• 3. Chest CT performed \< 4 weeks prior to bronchoscopy.
• 4. Voluntary informed consent to participate in the study.
• 1. Patients with prior lung consolidation, interstitial changes or lung masses (\> 3 cm in diameter) as seen on most recent CT
• 2. Lesions outside of the designated lung areas defined as inclusion criteria.
• 3. Known pregnancy
• 4. Vulnerable population
• 5. Ascites
• 6. Known diaphragmatic paralysis
• 7. Smokers or ex-smokers with known or suspected severe air-trapping defined as residual volume \> 150% of predicted
• 8. History of primary or secondary spontaneous pneumothorax
• 9. Lung bullae \> 5 cm
• 10. Patients with mediastinal or hilar adenopathy with high suspicion for malignancy in whom lymph node sampling is indicated and should occur prior to robotic bronchoscopy of the peripheral lesion.
• 11. Patient with active COVID pneumonia.