Warmest congratulations to Noah Medical, the parent company, on its Galaxy system surpassing 10,000 clinical cases worldwide! The number of surgeries has doubled in just seven months, and market recognition continues to rise.

We thank our partners for their strong support. As Noah Medical's subsidiary in China, Puli Ark will continue to deepen its expertise in the field of high-precision integrated lung diagnosis and treatment, working together to achieve the next milestone!

On March 11, 2026, medical robotics company Noah Medical announced that the results of a clinical study of its Galaxy System robotic bronchoscopy system had been published in the medical journal Respiratory Medicine.

Studies have shown that during robot-assisted bronchoscopy (RAB), the system's embedded real-time imaging technology can achieve three-dimensional localization of lung lesions and has obtained high consistency confirmation results in studies.

This clinical study highlights a key issue in robotic bronchoscopy techniques: how to confirm that 'the tool has indeed entered the lesion' after reaching it.

# A small clinical study reveals the image confirmation capabilities of the RAB system

The MATCH 2 study, published in Respiratory Medicine, primarily evaluates the performance of robotic bronchoscopy combined with real-time imaging technology in the localization of peripheral lung nodules.

This prospective, two-center, single-arm, non-randomized observational study included 31 patients with peripheral pulmonary nodules. All cases were performed using Noah Medical's Galaxy robotic bronchoscopy system. Intraoperative navigation relied on digital tomography (DT) and enhanced fluoroscopy (AF), and tool-in-lesion (TIL) access was independently confirmed by cone-beam computed tomography (CBCT).

The primary endpoint of the study was:

Successfully navigated to the target nodule.

• TIL confirmed by CBCT

The research results show that:

• Average nodule diameter: 16 mm (±6.7 mm)

• DT display achieves TIL: 30/31 (96.7%)

• Consistency between DT and CBCT results: 96.7%

• CBCT confirmed TIL: 29/31 (93.5%)

• Diagnostic acquisition rate under strict definition: 96.7% (30/31)

Regarding safety, one case of pneumothorax (3%) was recorded in the study.

The study authors believe that robot navigation combined with DT (Digital Transmission) and AF (Anatomical Focusing) can provide real-time positioning information during surgery and is consistent with CBCT (Computed Tomography-Carrying) confirmation results in most cases. However, the sample size of this study is small, and it still belongs to the stage of clinical observation regarding image-guided navigation capabilities.

# From 'finding the lesion' to 'confirming the location': The core challenges of robotic bronchoscopy

With the widespread adoption of lung cancer screening, the number of peripheral pulmonary nodules detected has continued to increase. However, in the minimally invasive diagnostic process, the industry has long faced two technical challenges: how to reach peripheral nodules within the complex bronchial tree structure and how to confirm that the biopsy tool has truly entered the lesion.

In traditional bronchoscopy, doctors typically rely on:

• Perspective (Fluoroscopy)

Electromagnetic navigation (EMN)

Radial ultrasound (r-EBUS)

However, in cases involving small nodules or distant lesions , localization errors and confirmation difficulties are significant. Therefore, recent technological developments in robotic bronchoscopy have primarily revolved around two main lines:

One path: A more stable navigation system

Representative systems include:

· Ion Endoluminal System（Intuitive Surgical）

· Monarch Platform（Johnson & Johnson）

The core objective is to improve:

• Bronchial pathway stability

• Control precision

• Remote reach capability

Two-path: Image Confirmation System

In recent years, the industry has gradually realized that navigation is not the same as confirmation. Therefore, various technology combinations have emerged:

• Intraoperative confirmation via CBCT

Digital Tomography (DT)

• Enhanced Perspective (AF)

AI navigation correction

Noah Medical's Galaxy system actually embeds real-time image confirmation capabilities into a robotic platform , attempting to reduce reliance on additional imaging equipment.

The research on MATCH 2 revolves around this combination of technologies.

# Noah Medical: A company that entered the market through the 'imaging + robotics' approach.

Noah Medical was founded around 2018 and is headquartered in Silicon Valley, California, USA. The founding team comes from the medical device and robotics industries, and its core product, the Galaxy System, received FDA approval in 2023 .

From a technical perspective, the characteristics of the Galaxy system are:

1. Robot navigation platform

Used for bronchial pathway operation and stability control.

2. Embedded real-time video

System integration:

Digital  tomography (DT)

Enhanced  perspective (AF)

Used to confirm the position of instruments in real time.

3. Intraoperative position update

The system can dynamically update the location of lesions during surgery, rather than relying entirely on preoperative CT scans.

The core logic of this line of thinking is:

Navigation errors can be compensated for through software and imaging capabilities.

In the current market for robotic bronchoscopy, this combination of technologies is still in the process of being validated.

# Implications for China's Medical Device Industry: RAB Competition is Shifting from 'Robotics' to 'Imaging Systems'

From an industry perspective, the competitive logic in the robotic bronchoscopy sector is changing.

The current mainstream global paths include:

Path 1: Relying on CBCT

A CBCT scanner is used in the operating room for intraoperative confirmation.

Features:

• Strong confirmation ability

High equipment costs

• High requirements for the operating room

Path 2: Embedded images within the robot system

Such as DT or enhanced perspective.

Features:

Integrated equipment

• The surgical procedure is simplified.

• Imaging capabilities are still being validated

The study disclosed by Noah Medical represents the accumulation of clinical evidence for the two-pathway approach.

For Chinese companies, this means:

The competition in robotic bronchoscopy may no longer be limited to mechanical structures and control systems, but will extend to:

Intraoperative imaging algorithm

• Navigation and image fusion

Software capabilities

In other words, RAB is transforming from 'robotic equipment' to 'imaging + robotic systems engineering'.

# Technology verification is still in its early stages

It should be emphasized that there are still clear boundaries in the MATCH 2 research:

• Sample size was only 31 cases

• No direct comparison with other RAB systems.

Therefore, this study is more of a verification of the technical path.

In the field of robotic bronchoscopy, what truly determines the maturity of the technology still includes multi-center studies, larger-scale samples, performance in different lesion scenarios, and comparison results with existing approaches.

However, from the perspective of industry development, the significance of this type of research lies in its ability to continuously provide new solutions to the key technical problem of 'image verification'.

Against the backdrop of continuously expanding lung cancer screening and rising detection rates of peripheral lung nodules, the technological competition surrounding minimally invasive diagnostic pathways continues to evolve.