For carefully selected fit patients with a small peripheral lung lesion, biopsy and curative robotic surgery can be performed under a single anaesthetic, with the same consultant performing both the diagnostic bronchoscopy and the robotic resection. 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: October 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 take place in one procedure, one admission and one recovery.
The defining principle of this approach is that surgical commitment follows the preliminary diagnosis. 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.
The combined procedure is the final, compressed form of the lung nodule precision pathway, which in most patients runs as two separate steps: ION biopsy as a day case, then robotic lung surgery once the pathology and staging are complete. For screen-detected nodules, the place of this procedure in an AI-assisted pathway is set out on the lung cancer AI pathway page.
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 with proceed-to-resection has been performed for decades. This pathway reverses the order of the two steps, and the difference is clinical as well as practical 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, so no incision is 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. A patient whose lesion turns out to be benign has had only a bronchoscopy.
Published experience
A 2026 review of single-anaesthetic programmes from the Mayo Clinic (Aizpuru et al., Cancers) reports that the in-theatre ROSE assessment agrees with final pathology in about 90% of cases, that the time from detection to resection is shortened by 15–51 days, and that hospital stay runs at 1.8–3.6 days; in one comparison the proportion of resected nodules that proved benign fell from 21.9% to 7.6%.
A single-centre series of 36 patients using the same workflow (Menghesha et al., Journal of Clinical Medicine 2026) found that 88.9% proceeded to resection after in-theatre confirmation, with no major complications. The evidence base is small, single-institution and high-volume, which is why patient selection on this page is deliberately narrow.
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.
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 standard: 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.
One reason a same-session tissue diagnosis is valuable: a peripheral nodule can prove to be small cell lung cancer, or a combined small cell and non-small cell tumour, and that changes both what operation is appropriate and what treatment follows it. When small cell lung cancer is found →
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. Insurer cover for the combined procedure varies, and the options are discussed with Jo Mitchelson before 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 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 #10 in the UK, the highest-ranked private hospital, in 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.
Fees. The two components of this pathway are priced separately on the fees page: ION robotic navigational bronchoscopy at London Bridge Hospital is £9,500–£10,500 and robotic segmentectomy is £25,000–£30,000, each covering hospital, surgeon and anaesthetist fees for an uncomplicated stay. When the two are performed under one anaesthetic, the hospital issues an individual written quote before booking, and that quote is the figure that applies. Hospital charges are the largest part of the total. All guide prices and how fees work →
Dr Okiror is recognised by AXA Health, Bupa, Aviva, Vitality, WPA and Cigna, and by most other UK and international insurers. When two procedures are performed under the same anaesthetic, most insurers apply a multiple-procedure rule, usually reimbursing the primary procedure (the segmentectomy) in full and the bronchoscopy element at a reduced rate, less any excess written into the policy. Pre-authorisation is obtained before any procedure, so that what the policy will and will not cover is known in advance. Self-paying patients are equally welcome.
This combined same-anaesthetic pathway is performed as part of Dr Okiror’s practice, with the same consultant carrying out both the diagnostic bronchoscopy and the robotic resection, so there is no handover between a diagnosing physician and a separate operating surgeon. Each case is evaluated individually at consultation. Surgery is usually within a week of completing investigations, and patients who already have their CT, PET-CT and lung function tests can be booked within days of the consultation.
The viability of this combined pathway depends on robotic surgical expertise at volume. The first three figures below are Dr Okiror’s personal record; the fourth is the Guy’s and St Thomas’ unit figure from the national audit.
519
Personal da Vinci robotic cases to June 2026
85 min
Average robotic lobectomy, vs 129 min European average
98
Robotic segmentectomies performed
99.59%
GSTT operative survival rate, vs 98.5% national average
Robotic case numbers and operative times: personal operative data and Intuitive Surgical platform data, to June 2026. European average: Intuitive Surgical European benchmarking data. The operative survival rate is the Guy’s and St Thomas’ NHS Foundation Trust figure from the SCTS National Thoracic Surgery Audit 2024–25; operative survival means survival of the operation itself, not long-term cancer survival.
Questions from patients and referring physicians about the combined biopsy and robotic surgery pathway.
Book a Consultation →Jo Mitchelson, PA
020 7952 2882
pa@lungsurgeon.co.uk
Appointments within 2–3 days. Surgery at London Bridge Hospital and The Lister Hospital Chelsea. Self-referrals welcome.
Jo Mitchelson, 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
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Robotic Lung SurgeryThe da Vinci programme at Guy’s and St Thomas’ and London Bridge Hospital, and the ION-to-da Vinci pathway
Lung Nodule Precision PathwayThe staged version of this pathway: consultant scan review, ION biopsy, then surgery if needed
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Lung Cancer Second OpinionIndependent review of scans, staging and the plan; video within 24 hours, report within 48–72 hours
Ground-Glass NoduleWhat a ground-glass nodule means, and when watching or surgery is the right path
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For Referring GPs & PhysiciansReferral routes, response times and direct contact for primary care and specialist colleagues
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