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Localization for Wedge Resection

3MM NODULE LOCALIZED FOR RESECTION
Author
Dr. Bhora, Dr. Raad

Thoracic Surgery

Mount Sinai West Roosevelt

New York, New York

Patient Information: 51 y/o, F

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

Nodule: LUL 4mm

Target Motion: 25mm

Biopsy Results: Metastatic Squamous Cell Carcinoma

Instruments Used: Always-On Tip Tracked® Forceps & SPiN Perc™

Conclusion: Localization for Wedge Resection

Observations

“Use of the Veran system was extremely helpful and allowed us to localize the tiny non-palpable nodule without the need to plan and coordinate with Interventional Radiology, thus decreasing the wait time prior to surgery. Moreover, there was less stress and anxiety for the patient. It enabled us to consolidate the procedures, and streamline care.”

Patient History
Patient had a history of a squamous cell carcinoma of the lip. CT scan of the chest revealed a 4mm indeterminate lung nodule. Localization and resection of this was planned to determine if this was a metastatic nodule for both staging and potentially therapeutic purposes.

Planning
Dr. Bhora and Dr. Raad used the Veran SPiN Planning™ software to create a plan to target a 4mm nodule in the LUL. In addition to identifying the target, an entry point for the localization needle was set to allow for easy setup and access to minimize OR time.

Procedure
The patient was placed on the OR table in the supine position. Lumen refinement was performed to accurately match the image and patient space prior to navigation. The percutaneous entry point was then identified by aligning the SPiN Perc™ 19ga UTW Always On Tip-Tracked® needle to navigate roughly 3mm medial to the set plan to keep the nodule intact for diagnosis. A 0.75mm Visicoil fiducial was successfully placed about 2-3mm deep in reference to the nodule. After placing the fiducial, transition to VATS wedge resection began and the patient was repositioned into a right lateral decubitus position. Fluoroscopy confirmed accurate placement of the fiducial. Once the tissue was resected, pathology confirmed the nodule was malignant and that it was indeed metastasis from the patient’s previous cancer.

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