For carefully selected fit patients with a small peripheral lung lesion, it is possible to perform biopsy and curative robotic surgery under a single anaesthetic. If the in-theatre preliminary assessment signals lung cancer, surgical resection proceeds immediately. If it does not, the patient wakes with no incisions and goes home the same day. All five technologies required for this pathway are available at London Bridge Hospital.
Last reviewed: April 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
For most patients with a suspicious lung lesion, the pathway from biopsy to surgical treatment spans several weeks: bronchoscopy or CT biopsy, laboratory pathology, MDT discussion, surgical listing, pre-operative assessment, separate admission for resection.
For a carefully selected group of fit patients with small peripheral tumours, that journey can be condensed into a single anaesthetic episode. Biopsy, preliminary in-theatre diagnosis, dye marking and robotic segmentectomy — one procedure, one admission, one recovery.
The defining principle of this approach is that surgical commitment follows the preliminary diagnosis — it does not precede it. If the in-theatre preliminary assessment does not signal cancer, the procedure ends. No incisions are made. The patient wakes and goes home the same day.
This pathway is offered to a select group of patients. Suitability is assessed individually at consultation. It is not appropriate for all patients with lung lesions.
Intraoperative frozen section analysis and proceed to resection has been performed for decades. This pathway is fundamentally different. The distinction matters clinically and for patients choosing between approaches.
Conventional Approach
The patient undergoes open or keyhole surgery first. The nodule is removed and sent for rapid frozen section pathology while the patient remains on the operating table.
If the result confirms cancer, anatomical resection proceeds. If it does not, the patient has still had a surgical incision, still had a wedge resection performed, and still faces a recovery.
Surgical commitment precedes diagnosis.
This Pathway
ION bronchoscopy reaches the lesion through the airways — no incision required. An onsite cytopathologist provides a preliminary assessment of the biopsy in theatre.
If the preliminary assessment signals lung cancer, dye marking and robotic resection follow immediately. If it does not, the patient has had no surgical incisions. They wake and go home the same day.
Surgical commitment follows diagnosis.
The key distinction: In the frozen section pathway, a surgical operation has already been performed before any tissue result is available. In this pathway, the patient undergoes no surgical incision unless the preliminary in-theatre assessment provides justification. For patients whose lesion turns out to be benign or non-malignant, this is the difference between an operation and a bronchoscopy.
Under a single general anaesthetic, five specialist technologies are combined in sequence. Each step depends on the one before it. The decision to proceed to surgery is made in theatre, informed by the ROSE preliminary assessment, pre-operative imaging, and clinical judgement.
The ION robotic bronchoscopy platform navigates to the peripheral lung lesion through the airways. No incision is made at this stage. ION can reach lesions in the outer third of the lung that conventional bronchoscopes cannot access — the population of nodules where biopsy has historically been most difficult.
Real-time intraoperative imaging confirms the position of the probe at the lesion before the biopsy is taken. This step reduces the risk of sampling error — a critical safeguard when proceeding to immediate surgery depends on the result being reliable. Cone beam CT is used on every case in this pathway, not selectively.
A cytopathologist is present in the operating theatre. The biopsy sample is assessed immediately, providing a preliminary signal within minutes. ROSE is not a definitive histological diagnosis — formal pathology follows in the laboratory in the usual way. If the preliminary assessment does not signal cancer, the procedure ends here. No surgical incisions are made. The patient wakes and goes home the same day.
If ROSE provides a preliminary signal of non-small cell lung cancer and the decision is made to proceed, the lesion is marked with dye. This intraoperative localisation guides the subsequent robotic resection, ensuring precise identification of the target lung segment on the outer surface of the lung.
The da Vinci Xi robotic platform is used to perform an anatomical segmentectomy — removal of the specific lung segment containing the tumour — through small keyhole incisions. Anatomical segmentectomy preserves more healthy lung tissue than wedge resection and delivers appropriate oncological resection margins for early-stage non-small cell lung cancer. Robotic segmentectomy overview →
This is not a routine pathway and is not appropriate for most patients with a lung lesion. It is considered for a specific group where the clinical picture supports combining biopsy and resection in a single anaesthetic episode.
The workup required before the procedure is straightforward — CT chest, PET-CT, lung function tests and routine blood tests. Patients who need invasive staging, complex mediastinal assessment, or who have significant comorbidities are generally not suitable.
Suitability is assessed at an individual consultation. If on review the clinical picture does not support the combined approach, a staged pathway is planned. No patient is committed to this sequence before the full assessment is complete.
This pathway is most appropriate for privately insured or self-pay patients who wish to move from diagnosis to treatment at pace and who meet the clinical criteria above. It is not suitable for everyone. In some cases, combining diagnostic bronchoscopy and surgical treatment in a single procedure may be appropriate. Coverage for this approach varies between insurers, and where needed, options can be discussed with Jo Mitchelson in advance of any commitment.
Dr Okiror consults and operates at both London Bridge Hospital and The Lister Hospital Chelsea. For this specific combined pathway, London Bridge Hospital is the appropriate venue for private patients. It holds all five required technologies — ION bronchoscopy, cone beam CT, onsite ROSE, dye marking capability and the da Vinci Xi robotic platform — and has the infrastructure to coordinate them within a single theatre session.
Primary private facility for this pathway. All five technologies in place. Ranked among the top ten hospitals in the UK — Newsweek World's Best Hospitals 2026.
Dr Okiror's second private operating base. Suitable for many lung surgery cases. Consultations and follow-up can take place at whichever hospital is more convenient.
This combined same-anaesthetic pathway has been developed and performed as part of Dr Okiror's practice. All five technologies required for this approach are in place at London Bridge Hospital for private patients assessed as suitable. Each case is evaluated individually at consultation. This pathway is offered to a carefully selected group of patients and is not appropriate for everyone.
The viability of this combined pathway depends on robotic surgical expertise at volume. The operative data below reflects Dr Okiror's personal record.
507
Personal da Vinci robotic cases to April 2026
85 min
Average robotic lobectomy — vs 129 min European average
95
Robotic segmentectomies performed
99.16%
Operative survival rate — vs 98.5% national average
Robotic operative times from Intuitive Surgical platform data. Survival and resection figures from SCTS National Thoracic Audit 2024–25. European average from Intuitive Surgical European benchmarking data.
Questions from patients and referring physicians about the combined biopsy and robotic surgery pathway.
Book a Consultation →Or call Jo Mitchelson:
020 7952 2882
Appointments within 2–3 days. Surgery at London Bridge Hospital and The Lister Hospital Chelsea. Self-referrals welcome.
Jo Mitchelson, Private PA · 020 7952 2882 · pa@lungsurgeon.co.uk
St Thomas' Hospital #1 UK · Guy's Hospital #2 UK · London Bridge Hospital #10 UK · Newsweek World’s Best Hospitals 2026
Anatomical lung resection for early-stage lung cancer — surgical detail, outcomes and private access
Lung Nodule SurgeryAssessment, biopsy and surgical treatment for suspicious lung nodules
Second Opinion ServicePrivate second opinion appointments within 2–3 days — how to prepare and what to bring