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Localization for Wedge Resection Preserves Lung

LOCALIZATION OF RIGHT UPPER LOBE (RUL) NODULE
Author
Dr. Parvez Sultan & Dr. Jay Heidecker

St. Vincent’s Birmingham

Birmingham, AL

Patient Information: 61 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RUL 18mm

Target Motion: 8mm

Biopsy Results: Benign; Infection

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

Conclusion: Granuloma

Observations

“The accurate localization of this nodule in a difficult location was key in obtaining a diagnosis. The benign diagnosis let us preserve lung tissue by stopping the procedure after resecting the wedge with the infectious nodule.”

Patient History
This patient is a former smoker with a suspicious nodule in the right upper lobe that has grown in size over the past year.

Planning
The patient was scanned in the right lateral decubitus position. Dr. Heidecker made a plan to reach the target through the right chest wall, carefully avoiding the RUL/RML fissure. Based on location and depth, it was determined SPiN Perc™ Localization Needle with 1cm marking zone was necessary to reach and mark for resection. The planning process took roughly 5 minutes.

Procedure
The patient was intubated using a single lumen tube and positioned in a right lateral decubitus position for surgery. Dr. Heidecker completed initial registration using main carina alignment and transitioned to SPiN Perc™ for the localization. He was able to quickly line up the needle according to the planned trajectory, carefully avoiding the fissure. During an expiration breath hold and matched respiration gating, Dr. Heidecker injected 0.6cc of dye into the 18mm nodule.

Dr. Sultan transitioned into the robotic resection for wedge resection of the nodule. The dye was easily visualized and spot on accurate for the nodule. A wedge was resected with clear margins. Pathology called a diagnosis of benign granuloma. This diagnosis allowed no further lung tissue to be removed or future treatments.

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