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Localization and Diagnosis of Nodule Spares Patient Lobectomy

LOCALIZATION OF A 6MM GGO NODULE
Author
Dr. Keriann Van Nostrand, Pulmonologist

Dr. Onkar Khullar, Thoracic Surgeon

Emory Midtown Healthcare

Atlanta, GA

Patient Information: 56 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RLL 7mm

Target Motion: 35mm

Biopsy Result: Benign

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

Conclusion: Infection

Observations

“In this case, Veran’s respiratory gating technology was important in allowing me to precisely determine the optimal time to advance my needle and inject dye into a moving nodule. Using this system enables me to accurately localize these lesions for our thoracic surgeons and ensure we are providing the best care.”

Patient History
This patient had a history of squamous cell cancer in the tongue. During a routine follow-up CT scan, a pulmonary nodule was discovered in the right lower lobe. The patient was referred to the thoracic team at Emory for a plan to diagnose the nodule.

Planning
Due to the location and size of the lesion, Dr. Khullar would not be able to palpate or visualize the nodule. He decided to collaborate with pulmonologist Dr. Van Nostrand to localize the nodule prior to resection using the SPiN Thoracic Navigation System™. The patient was scanned in the lateral decubitus position using Veran CT protocol. This would allow Dr. Khullar to begin resection after localization without patient repositioning. Upon review of the CT scan, Dr. Van Nostrand created a plan to reach the target using a percutaneous approach. Based on location and depth, she determined the 105mm SPiN Perc™ introducer needle would be needed to mark the nodule for resection.

Procedure
Dr. Van Nostrand first used the Always-On Tip Tracked® forceps to perform endobronchial registration with the patient already in the lateral decubitus position for surgery. The procedure transitioned to SPiN Perc™ for percutaneous localization. When respiration was matched, Dr. Van Nostrand advanced the SPiN Perc™ introducer needle through the chest wall to reach the targeted nodule. She then injected 0.8cc of dye through the needle, using half to make a trail out to the chest wall. Dr. Khullar began his resection procedure using robotics and easily identified the dye marking and location of the nodule. Upon wedge resection, pathology confirmed an accurate marking of a pulmonary nodule with a diagnosis of infection. Dr. Khullar remarked he would he would not have been able to identify this small, GGO nodule without an accurate localization. The infectious nodule was fully removed in the wedge resection. This allowed Dr. Khullar to only remove the lung tissue needed for diagnosis and spare the patient from a full lobectomy.

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