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

Inclusion Criteria: Adult patients (≥ 18 years old) undergoing diagnostic robotic bronchoscopy for a lung nodule suspicious for malignancy bronchoscopy under general anesthesia. 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. Chest CT performed < 4 weeks prior to bronchoscopy. Voluntary informed consent to participate in the study. Exclusion Criteria: Patients with prior lung consolidation, interstitial changes or lung masses (> 3 cm in diameter) as seen on most recent CT Lesions outside of the designated lung areas defined as inclusion criteria. Known pregnancy Vulnerable population Ascites Known diaphragmatic paralysis Smokers or ex-smokers with known or suspected severe air-trapping defined as residual volume > 150% of predicted History of primary or secondary spontaneous pneumothorax Lung bullae > 5 cm 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. Patient with active COVID pneumonia.