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Localization and Resection in One Procedure

RIGHT UPPER LOBE (RUL) PERCUTANEOUS LOCALIZATION
Author
Dr. Galen Ohnmacht

Thoracic Surgeon

University of Maryland

Baltimore Washington Medical Center

Glen Burnie, Maryland

Patient Information: 78 y/o, M

Scan Protocol: Veran’s Inspiration/Expiration CT Scan Protocol

Nodule: 33mm

Target Motion: 15mm

Instruments Used: SPiN Perc™ Needle

Conclusion: Lepidic Adenocarcinoma of the Lung and RUL Lobectomy

Observations

“We were able to localize this deep, diffuse, non-palpable ground glass density rapidly and with single resection. Without localization with the methylene blue finding the mass would have been far less reliable, if even possible, and certainly would have required additional OR time. This also would have likely required larger and/or additional resections.”

Patient History
The patient is a 78 year-old  male with a 20 pack-year history. A visit to his PCP for a  workup of an unrelated disease showed a right upper lobe mass off 3. 3cm. He was referred to thoracic surgery, and the decision was made to localize percutaneously and perform a wedge resection .

Planning
Upon review of the CT scan, it was identified how posterior this Methylene Blue injection would be. Based on the size and location of the lesion, it was determined that a longer 19ga Always-On Tip Tracked®  needle was necessary to reach and localize for resection. The distance was 128mm from skin surface to target with 15mm of nodule motion. The planned path was made to be adjacent to the rib and avoid the  fissures . The planning process took roughly 5 minutes.

Procedure
Prior to the injection, accuracy was verified by checking the main and secondary carinas . The target was confirmed and the procedure was converted to SPiN Perc™. Using a non- sterile needle to mark the entry point, the patient was prepped and draped  for percutaneous localization. When respiration was matched, the needle was advanced to the target and  1ml  of Methylene Blue was injected into the lesion. A trail of dye was left from the lesion to the chest  wall to aid in identification for wedge resection. After the localization was complete, the patient was prepped for surgical resection. Navigation allowed for localization and resection to be completed in under 45 minutes. Final path revealed Lepidic Adenocarcinoma of the lung, so the patient underwent a complete RUL lobectomy.

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