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Localization of GGO Lung Nodules

LOCALIZATION AND RESECTION OF 2 LLL NODULES
Author
Dr. Jess K. Joymon

Cardiothoracic Surgeon

Sky Ridge Medical Center

Lone Tree, CO

Patient Information: 71 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: LLL 13mm & 9mm

Biopsy Result: Malignant

Instruments Used: Always-On Tip Tracked® Serrated Forceps & SPiN Perc™ 2cm Localization Needle

Conclusion: Adenocarcinoma; lobectomy of left lower lobe

Observations

“In the resected wedge containing the GGO lesions, there were no palpable lesions. There is no way I could have successfully resected these lesions without localizing with Veran.”

Patient History
This patient has a 100 pack-year smoking history. He presented with 2 suspicious ground-glass opacity lesions in the left lower lobe. Due to the patient’s history, Dr. Joymon decided to perform a diagnostic resection of the lesions.

Planning
As the nodules of interest were in the posterior LLL, Dr. Joymon decided to scan the patient in the left lateral decubitus position using Veran CT scan protocol with the vPad™ Patient Tracker pads placed on the spine. Dr. Joymon used the Veran SPiN Planning™ software to mark both GGO lesions with spheres, as they were too diffuse for segmentation. In planning his approach, he noted both targets were 1.5cm from the pleura and decided to use the 2cm SPiN Perc™ Localization Needle to access and accurately dye mark the nodules.

Procedure
The patient was brought to the OR and prepped in the thoracotomy position for surgery. After performing endobronchial registration, Dr. Joymon transitioned to SPiN Perc™ to localize both nodules. Carefully lining up his trajectory to avoid the patient’s ribs, Dr. Joymon injected 0.7mL of dye into each nodule with two separate percutaneous entry points. The procedure then transitioned to a thorascopic wedge resection. Dr. Joymon resected the tissue with both of the dye markings in one wedge. Final pathology revealed a diagnosis of adenocarcinoma. The patient was again discussed at multi-disciplinary conference and was recommended for a completion lobectomy. Dr. Joymon then took the patient back to the OR for a VATS completion left lower lobectomy.

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