To our knowledge, this is the first reported case of successful transbronchial biopsy via RB in a 5-year-old patient. The sample revealed a potential diagnosis, but more importantly, helped rule out an active infectious process and avoided an open lung biopsy which was being planned and would have otherwise been necessary to establish a diagnosis. We believe this technology can be used to increase the diagnostic yield of flexible bronchoscopy, particularly in the immunocompromised population as there is already evidence supporting image-guided bronchoscopy over conventional bronchoscopy in this population [(4)](#ref-0004). A notable limitation to RB is the size of the available bronchoscopes for robotic platforms (4.5 and 3.5 mm OD). In children, this may limit the capacity to sample more peripheral lesions via fine needle aspiration, as more lung tissue (relative to chest size) may be injured. In our case, the catheter tip was never as close to the lesion as it has been described in adults [(2)](#ref-0002). As the field of pediatric interventional pulmonology continues to develop, RB will likely be one of several options available for safe and high-yield diagnostic procedures.
This case illustrates another promising example of the recent advances within pediatric interventional bronchoscopy. As innovative medical therapies continue to make their way into the pediatric realm (e.g. a 1.1-mm flexible cryoprobe has been recently developed by Erbe), opportunities for novel approaches and techniques will continue to present themselves.