ION robotic navigational bronchoscopy is a way of biopsying small lung nodules through the airways, with no cut to the chest. The Ion endoluminal system steers an ultra-thin, shape-sensing catheter out to nodules in the outer lung that a conventional bronchoscope cannot reach, and nodules as small as 6 mm have been sampled this way in the UK programme. Dr Lawrence Okiror, Consultant Thoracic and Robotic Surgeon (GMC 6150382), performs it privately at London Bridge Hospital as a day case under general anaesthetic. On every case, cone-beam CT confirms the needle is in the nodule before a sample is taken, and a pathologist in the room examines the tissue while the catheter is still in place, so most patients leave with a preliminary diagnosis the same day. All-inclusive guide price £9,500–£10,500. Consultations within 2–3 days. Self-referrals welcome.
Last reviewed: October 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
A shape-sensing robotic catheter reaches nodules in the outer lung, in all parts of both lungs, that a standard bronchoscope cannot.
A CT taken in the room with the catheter in place confirms the needle is in the nodule before any sample is taken.
A pathologist checks the tissue while the catheter is still in place, so most patients have a preliminary diagnosis on the day. The full laboratory report follows and may refine it.
Home the same day in most cases. A small air leak around the lung in around 2% of cases in the GSTT programme, all minor.
Guide price covering consultant, anaesthetist, hospital, cone-beam CT and pathology. Written estimate before anything is booked.
ION robotic navigational bronchoscopy is a biopsy of a lung nodule performed through the airways with the Ion endoluminal system. A robotic, shape-sensing catheter is steered along a route planned on your CT scan to a nodule in the outer lung, its position is confirmed with cone-beam CT, and tissue is taken through it. The same procedure is also called robotic-assisted bronchoscopy, shape-sensing robotic-assisted bronchoscopy (ssRAB), navigational bronchoscopy or robotic lung biopsy. It is performed under general anaesthetic as a day case, with no incision.
Dr Lawrence Okiror, Consultant Thoracic and Robotic Surgeon (GMC 6150382), performs ION robotic navigational bronchoscopy privately at London Bridge Hospital. He works within the Guy’s and St Thomas’ thoracic surgery ION programme, which performed approximately 635 procedures in 2024–25, and leads its clinical audit.
The all-inclusive guide price at London Bridge Hospital is £9,500–£10,500, covering the consultant and anaesthetist fees, the hospital day-case and theatre charges, cone-beam CT, rapid on-site evaluation and full histology, the post-procedure chest X-ray and the results consultation. A written itemised estimate is provided before anything is booked. Most private medical insurers cover diagnostic bronchoscopy where a nodule needs a tissue diagnosis.
The same surgeon who performed the biopsy carries out the operation where one is needed: robotic lung-sparing resection at London Bridge Hospital, after discussion at the chest multidisciplinary team meeting. Patients who want the diagnosis and the robotic resection on the same day, under the same anaesthetic, can be assessed for the combined pathway. Most nodules referred for ION do not need an operation.
The airways branch again and again as they run out from the windpipe, and each branch is narrower than the last. A conventional bronchoscope, a flexible camera passed through the mouth under sedation or anaesthetic, reaches the first few generations of branching and can sample what sits beside them. Most of the nodules found on CT scans sit further out than that, in the outer third of the lung, where the airways are too narrow for a standard instrument. Until recently the choices for those nodules were a needle through the chest wall under CT guidance, with its risk of lung collapse, or a surgical biopsy.
The Ion endoluminal system, made by Intuitive, changes that. Before the procedure, your CT scan is used to plan a route through the airways to the nodule. On the day, an ultra-thin, fully articulating catheter is driven along that route by a robotic arm. A fibre inside the catheter reports its own shape hundreds of times a second, so the system knows where the tip is at every moment and keeps it there while the biopsy tools pass through it. The manufacturer describes the catheter as able to reach nodules in all 18 segments of the lung. In the UK programme, nodules as small as 6 mm have been biopsied.
Its purpose is the biopsy of lung nodules and the diagnosis of lung nodules that sit beyond the reach of a standard bronchoscope: accessing small nodules within the lung, taking a lung nodule biopsy from them, and bringing back enough tissue for a diagnosis. You will see several names for the same procedure. ION robotic navigational bronchoscopy, robotic-assisted bronchoscopy, shape-sensing robotic-assisted bronchoscopy (ssRAB in the medical literature), navigational bronchoscopy and robotic lung biopsy all describe the biopsy of a lung nodule through the airways using the Ion system. They mean the same thing, and this page uses them interchangeably.
Most lung nodules do not need a biopsy at all; that is decided on the CT first, from the nodule’s size, appearance, growth between scans and your own history. The lung nodule, ground-glass nodule and shadow on a scan pages set out how. ION is the route when tissue is needed and the nodule sits where a catheter can reach it.
A fibre inside the catheter reports its shape and position continuously, so the tip can be held still in a small airway while the biopsy is taken.
Your CT scan is used to map the airways and plan the path to the nodule before you arrive.
A CT taken in the room shows the needle and the nodule together before any sample is taken, on every case.
Rapid on-site evaluation of the first samples while the catheter is still in the nodule, on every case.
Performed under general anaesthetic through the mouth. Most patients go home the same day after a chest X-ray.
The accuracy of a navigational bronchoscopy is decided by one thing: whether the biopsy tool is inside the nodule when the sample is taken. In the UK multicentre study of the Ion system, reported in December 2025, the tool was confirmed inside the nodule in 198 of 200 patients (99%) and a diagnosis was obtained in 184 of 200 (92%). Cone-beam CT is how that confirmation is obtained, and on this pathway it is used on every case rather than selectively.
The reason it matters is that the nodule moves. The CT used to plan the route was taken days earlier with the lungs full of air; under anaesthetic, with the lung partly deflated and moving with the ventilator, the nodule sits several millimetres from where the plan says, often further than the nodule is wide. A system navigating on the planning scan alone can arrive exactly where the nodule used to be.
Cone-beam CT closes that gap. With the catheter in position, a CT is taken in the room showing the catheter, the needle and the nodule in one image; if they do not coincide the catheter is adjusted and the scan repeated, and only then is the sample taken. The medical term is tool-in-lesion confirmation. In plain words, it is the check that the needle is in the nodule and not in the lung beside it.
The UK study was a single-arm study at two specialist centres, sponsored by the manufacturer; it shows what ION achieved there, and does not compare ION with other biopsy routes. No biopsy technique reaches 100%, and a nodule can be too small, too soft or too awkwardly placed for any route. What cone-beam CT on every case gives you is that when the sample comes back benign, it was taken from the nodule and not from beside it, so the result can be trusted and does not have to be repeated. How the other tests fit around it →
On every ION case at London Bridge Hospital, a pathologist who specialises in reading cells (a cytopathologist) is present in the procedure room. The first samples go straight onto a slide and under the microscope while the catheter is still in the nodule. This is rapid on-site evaluation, usually shortened to ROSE, and it means most patients have a preliminary diagnosis before they leave the hospital. The full histology report follows over the next few days and can refine or occasionally change that preliminary reading, which is why it is given as a preliminary result and not a final one.
ROSE does two things. If the material on the slide is not adequate, more is taken then and there, with the catheter already in position, rather than at a second procedure weeks later. Once the sample is confirmed diagnostic, further passes are taken so there is enough tissue for the tests that decide treatment if the nodule is cancer: the exact type, and the genetic tests that decide whether a targeted drug or immunotherapy is an option.
On a recent ION list of five patients performed by Dr Okiror, cone-beam CT and rapid on-site evaluation were used on every case, and four of the five had a preliminary diagnosis in the room. One of the four had already had a CT-guided needle biopsy elsewhere, reported as showing no cancer, for a nodule whose appearance on the scan said otherwise; ION sampled the nodule itself, and the pathologist confirmed in the room that it was cancer. In the fifth patient the cytopathologist judged the material suggestive but not conclusive, and the answer came from the full histology a few days later.
That fifth case is why the result on the day is called preliminary. ROSE gives most patients an answer the same day; the full laboratory report is the final answer in every case.
An addition to the ION procedure. The trial below tested the probe, not ION, and says nothing about whether ION is better than other routes.
Forceps and a fine needle take small samples. For nearly all of his ION cases at London Bridge Hospital, Dr Okiror also passes a 1.1 mm cryoprobe through the Ion catheter: the tip freezes to the nodule for a few seconds and brings back a piece of tissue about twice the size of a forceps sample, without crushing it. That is the tissue the laboratory needs for genetic testing, and it is why a second biopsy for more tissue is rarely needed.
In the FROSTBITE-2 randomised trial of 500 patients, published in JAMA in 2026, the 1.1 mm cryoprobe gave a diagnosis in 83% of lung nodules and masses against 70% with forceps, and no patient in the cryoprobe group had a collapsed lung. Two things to know about that trial: it was not performed with robotic navigation, so how much the probe adds on top of cone-beam CT and ROSE has not yet been measured; and it was funded by the probe’s manufacturer.
ION cannot biopsy every lung nodule. A nodule with no airway running near it may be better approached with a needle through the chest wall or by surgery, and many small nodules should simply be followed with a repeat CT. ION does not make a biopsy necessary; whether tissue is needed at all is decided on the scan first.
Where the nodule is a possible small cell lung cancer, or a cancer on targeted treatment that may have changed type, the diagnosis depends entirely on the tissue, and the amount and quality of the sample decide what can be done next.
Each samples a different place, and the choice follows where the tissue has to come from. A patient with a nodule in the outer lung and enlarged lymph glands in the centre of the chest may reasonably have ION and EBUS in the same anaesthetic.
| Route | What it samples | How | Main risk | Setting |
|---|---|---|---|---|
| ION robotic navigational bronchoscopy | Nodules in the outer lung, from about 6 mm, in any segment | Robotic catheter through the mouth, cone-beam CT confirmation, ROSE | Pneumothorax around 2% in the GSTT programme, nearly always minor | General anaesthetic, day case |
| EBUS (endobronchial ultrasound) | Lymph glands and masses in the centre of the chest, beside the main airways | Ultrasound probe on a bronchoscope, needle through the airway wall | Low; occasional bleeding or infection | Sedation or general anaesthetic, day case |
| CT-guided needle biopsy | Nodules near the chest wall, approached from outside | Needle through the skin and chest wall under CT | Pneumothorax is the main risk and a proportion need a chest drain; less reliable for small or deep nodules | Local anaesthetic, usually day case |
| Surgical biopsy | Any nodule, removed whole, or whole lymph nodes by cervical mediastinoscopy | Keyhole or robotic operation | Risks of an operation | General anaesthetic; wedge biopsy usually one night |
Whether ION or a CT-guided needle biopsy gives the better result for a small nodule has not yet been settled by a randomised trial. One is now recruiting: ENCOMPASS (ClinicalTrials.gov NCT07761351), sponsored by Intuitive, randomises patients with a nodule under 2 cm and no prior biopsy between CT-guided biopsy and shape-sensing robotic-assisted bronchoscopy, with sites in London, Heidelberg and Basel. Until it reports, the choice rests on where the nodule sits, whether an airway leads to it, and the risk of a collapsed lung with each route, set out in the table above.
Where EBUS has not answered the question, a negative result against a strong suspicion, an inadequate sample, a diagnosis such as lymphoma that depends on the structure of the whole gland, or too little tissue for a molecular panel, cervical mediastinoscopy takes whole nodes as a day case. Where a nodule cannot be reached by any catheter route and the question still has to be answered, surgical lung biopsy removes it. The full sequence of scans and tests is set out on chest imaging explained.
A consultation within 2–3 days of contacting the practice, at which Dr Okiror reviews your CT personally and confirms ION is the right route. Pre-assessment and, where needed, a PET-CT are arranged. The route to the nodule is planned on your scan.
General anaesthetic at London Bridge Hospital. The catheter is navigated to the nodule, cone-beam CT confirms the position, samples are taken and examined in the room by the pathologist. Usually 30 to 60 minutes.
Recovery, a chest X-ray to check for air around the lung, and home the same day in most cases. A sore throat for a day or two is usual. A small air leak around the lung (a minor pneumothorax), in around 2% of cases, may mean a small drain overnight.
The preliminary result from the room, then the full histology within days, and molecular results after that where a cancer is found. Dr Okiror gives you the result himself and the letter goes to you and your GP.
The all-inclusive guide price for ION robotic navigational bronchoscopy at London Bridge Hospital is £9,500 to £10,500. The figure is quoted as a range because the hospital component varies with the day-case bed and theatre time used; a written itemised estimate is prepared by Jo Mitchelson and confirmed before a date is booked.
Most private medical insurers cover diagnostic bronchoscopy where a nodule needs a tissue diagnosis. Dr Okiror is recognised by AXA Health, Bupa, WPA, Vitality, Cigna, Aviva, Allianz and most other UK insurers. Jo Mitchelson obtains pre-authorisation before a date is confirmed.
For an estimate against your own scan: 020 7952 2882 or pa@lungsurgeon.co.uk. Patients travelling from outside the UK are seen by video first; see international patients.
Most nodules referred for ION do not need an operation. Where the biopsy confirms a cancer that should be removed, the surgeon who took the biopsy performs the operation: robotic lung-sparing resection at London Bridge Hospital, with segmentectomy rather than lobectomy wherever the cancer allows it. Staging is completed first and every case is discussed at the chest multidisciplinary team meeting before a surgical decision is made.
For patients who would like to proceed from diagnosis to robotic resection on the same day, under the same anaesthetic, London Bridge Hospital offers a combined pathway. ION reaches the nodule and the pathologist confirms cancer in the room; the da Vinci robotic resection then follows without waking the patient. It suits a nodule that is highly likely to be cancer on the scan, in a patient who has been staged, found fit for surgery, discussed at the multidisciplinary team meeting and consented for both parts beforehand. If the pathologist cannot confirm cancer in the room, the operation does not go ahead and the histology is awaited.
One consultant performs both parts. The combined biopsy and robotic surgery pathway →
Your CT or PET-CT reviewed personally at the first appointment. Risk assessed, plan agreed. The precision pathway →
Tissue from the nodule, confirmed in position by cone-beam CT, checked in the room. You are here.
PET-CT, lung function and multidisciplinary review where a cancer is found. Tests and staging →
Lung-sparing robotic resection by the same surgeon. Robotic lung surgery → · Lung cancer surgery in 2026 →
Dr Lawrence Okiror performs ION robotic navigational bronchoscopy privately at London Bridge Hospital, which in November 2023 became the first private hospital in Europe to offer the Ion system in routine clinical practice. Consultations are available within 2–3 days at London Bridge, The Lister Hospital Chelsea, Canary Wharf and the City of London; the procedure itself takes place at London Bridge. Self-referrals welcome.
As a thoracic surgeon, he performs the biopsy and, where one is needed, the operation. Patients are not handed to a second team between diagnosis and treatment.
Dr Okiror works within the Guy’s and St Thomas’ thoracic surgery navigational bronchoscopy programme, one of the busiest in the UK, which performed approximately 635 ION procedures in 2024–25. As the department’s clinical audit lead he is responsible for how that programme’s results are captured and reviewed each month, and the figures on this page come from that audit.
St Thomas’ Hospital #1 UK · Guy’s Hospital #2 UK · London Bridge Hospital #10 UK · Newsweek World’s Best Hospitals 2026, independently assessed across 32 countries.
What to send
The CT is reviewed personally before ION is recommended.
Nodule referral criteria →
GP referral information →
GP clinical briefing →
Imaging & screening clinic referral route →
The questions patients and referring clinicians ask most often before an ION robotic navigational bronchoscopy at London Bridge Hospital.
Request a consultation →Or call Jo Mitchelson:
020 7952 2882
Self-referrals welcome. Consultations within 2–3 days at London Bridge Hospital, The Lister Hospital Chelsea, Canary Wharf or the City of London. Dr Okiror reviews your scan personally and tells you whether ION robotic navigational bronchoscopy is the right next step, or whether a repeat scan is the better answer.
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