This study is designed to evaluate clinical safety and diagnostic accuracy of the robotic-assisted bronchoscopy with biopsy performed with the Monarch™ Endoscopy Platform in a broad range of patients with pulmonary lesions.

Despite technological advancements in guided bronchoscopy such as electromagnetic navigation bronchoscopy and radial probe endobronchial ultrasound, successful biopsy of peripheral pulmonary lesions remains a challenge due to a number of factors, one of which may be the ability to gain access to peripheral lesions due to the size and maneuverability of conventional bronchoscopes. The diagnostic yield of conventional bronchoscopic approaches for peripheral lesions remains suboptimal.

A novel robotic assisted bronchoscopy procedure now exists for patients with lung nodules. This procedure is performed using the Monarch™ platform (Auris Health, Inc., Redwood City, CA). This study is expected to enroll up to 1200 patients at up to 30 investigative sites.

Inclusion Criteria:

1. Over 21 years of age;
2. Capable and willing to give informed consent;
3. Acceptable candidate for an elective, non-emergent bronchoscopic procedure;
4. Lung lesions, 8 mm to 50 mm in size, requiring bronchoscopic diagnosis which were identified on thin slice CT scan within 28 days of the intended bronchoscopy

Exclusion Criteria:

1. Medical contraindication to bronchoscopy as assessed by the investigator
2. Presence of uncorrectable bleeding disorders
3. Medical devices interfering with electro-magnetic navigation, including but not limited to pacemaker
4. Patients with the target lesion having endobronchial involvement seen on chest CT
5. Lack fitness to undergo flexible bronchoscopy as determined by the bronchoscopist prior to procedure,
6. Participation in any other clinical trial within 30 days of enrollment that would interfere with this study;
7. Uncontrolled or irreversible coagulopathy;
8. Female subjects who are pregnant or nursing at the time of the procedure or those of child-bearing potential refusing a pregnancy test prior to the procedure;
9. CT scan done greater than 28 days before the bronchoscopy procedure.

Patients with indeterminate pulmonary nodules considered to undergo a bronchoscopy procedure per standard of care.