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Localization Allows a Lung Tissue Sparing Procedure

LOCALIZATION FOR PATIENT WITH PRIOR LOBECTOMY
Author
Dr. Jussuf Kaifi

Thoracic Surgeon

University of Missouri Healthcare

Columbia, MO

Patient Information: 72 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RLL 6mm

Target Motion: 14.33mm

Biopsy Result: Malignant

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

Conclusion: Successful Segmentectomy with Negative Margins

Observations

“This surgery was more complex as the patient previously had a lobectomy in the same lung. We were able to localize a deep, 17mm GGO nodule that is usually non-palpable with a hook guidewire placement. The localization with Veran allowed us to do a minimally-invasive and lung parenchyma-sparing procedure.”

Patient History
This patient has a history of smoking and previous lung cancer. Two years ago, the patient had an occurrence of adenocarcinoma which was removed by Dr. Kaifi via a right upper lobe lobectomy. A recent routine follow-up scan revealed a new, 6mm RLL GGO nodule.

Planning
Due to the GGO nature and size of the lesion, Dr. Kaifi would not be able to palpate or visualize the nodule and decided he would need Veran to localize prior to resection. The patient was scanned in the lateral decubitus position with Veran CT protocol. Upon review of the CT scan, Dr. Kaifi made a plan to reach the target using a percutaneous approach. Based on location and depth, he determined the 105 mm SPiN Perc™ introducer needle would be needed to mark the nodule for resection with hook-wire placement.

Procedure
The nodule was in a challenging location, sitting right behind the scapula. Dr. Kaifi completed initial registration using Always-On Tip Tracked® serrated forceps and transitioned to SPiN Perc™ for the localization. During an expiratory breath hold, he advanced into the nodule with the SPiN Perc™ introducer needle and inserted a pre-measured hook-wire to mark the nodule. This pre-operative localization took a total of 10 minutes. The procedure transitioned into robotic resection. Dr. Kaifi easily identified the hook-wire and removed the wedge. Pathology confirmed the small GGO nodule was present in the wedge and diagnosed lepidic adenocarcinoma in-situ, which made the patient a good candidate for a segmentectomy. The accurate localization allowed Dr. Kaifi to spare lung tissue and remove just a segment of the RLL rather than a full lobectomy.

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