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Accurate Localization Helps Confirm Metastatic Diagnosis

LOCALIZATION OF A LUL NODULE
Author
Dr. John Gouldman

Thoracic Surgeon

Northside Atlanta Hospital

Atlanta, GA

Patient Information: 35 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: LUL 16mm

Target Motion: 33mm

Biopsy Result: Malignant

Instruments Used: Always-On Tip Tracked® Forceps & SPiN Perc™ 1cm Localization Needle

Conclusion: Metastatic Colorectal Cancer

Observations

“Using robotics you have no haptic feedback; an efficient way to localize difficult nodules is key in resecting the targeted tissue.”

Patient History
This young patient was previously diagnosed and treated for colorectal cancer in 2018. During a routine follow-up scan, a nodule was discovered in the left upper lobe. Due to the small size and peripheral location, Dr. Gouldman decided to move straight to resection for a diagnosis.

Planning
The patient was scanned in the supine position using the Veran CT scan protocol. Upon reviewing the CT scan, thoracic surgeon Dr. Gouldman identified and segmented the 16mm nodule with the Veran SPiN Planning™ software. It was noted during the expiration scan review, the nodule moved over twice its size (33mm) during each respiratory cycle. Respiratory gating would be extremely important to accurately mark the nodule. Dr. Gouldman planned a trajectory to reach the nodule percutaneously using the SPiN Perc™ 1cm Localization Needle.

Procedure
Dr. Gouldman first used the Always-On Tip Tracked® Forceps to perform endobronchial registration with the patient in the supine position. The procedure then transitioned to SPiN Perc™ for percutaneous localization. Dr. Gouldman lined up his trajectory and advanced the needle slightly distal to the targeted peripheral nodule, to avoid any pleural dissipation. Visualizing the needle’s marking zones on the Veran system, Dr. Gouldman injected 0.6cc of dye into the nodule. This localization process took a total of 10 minutes, and the procedure transitioned to robotic resection. The dye marking was clearly seen on the nodule, as well as a trail to the chest wall where Dr. Gouldman had advanced the needle. Upon wedge resection, pathology confirmed an accurate marking of a malignant nodule. Final pathology revealed metastatic colorectal cancer. The accurate localization and diagnosis of the nodule allowed the patient care team to immediately plan treatment.

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