Navigational bronchoscopy in India - Current landscape and future frontiers: A case based narrative review

Peripheral pulmonary lesions (PPL) are increasingly being detected due to widespread utilization of computed tomography scans.Though bronchoscopic biopsy has been shown to be much safer than CT based biopsy, it is limited by difficulties in accurately navigating the bronchoscope to the lesion.Several technologies have been introduced which help the interventional pulmonologist to guide the bronchoscope accurately to the target lesion, and utilizing these is labelled as "Navigational Bronchoscopy".These navigational technologies have significantly impacted the field of interventional pulmonology, offering safer, more accurate, and minimally invasive techniques for diagnosing and managing peripheral pulmonary lesions (PPLs).While multiple navigation systems have become widespread globally, their adoption in India is limited by resource availability, cost constraints, and clinical infrastructure restraints.This review provides a detailed analysis of currently available navigational technologies in India, including virtual bronchoscopy navigation (VBN), cone-beam computed tomography (CBCT), C arm based tomo-synthesis (CABT) and bronchoscopic transparenchymal nodule access (BTPNA).The review outlines the principles, benefits, limitations, and integration of these tools in clinical practice within the Indian context.