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Navigation Essential to Localize Nodule in a Difficult Location

Dr. Brian Furukawa & Dr. Salman Zaheer

Pulmonologist, Thoracic Surgeon

Loma Linda University Medical Center

Loma Linda, CA

Patient Information: 18 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan

Nodule: 9mm

Target Motion: 18mm

Biopsy Result: Malignant

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

Conclusion: Metastatic Osteosarcoma


“Utilizing Veran technology to localize this nodule immediately before the procedure started made it quick and easy for me to identify where to resect upon starting surgery.”

Patient History
This 18-year-old male has a history of osteosarcoma with metastasis to the lung. He previously had a malignant nodule in his right lung which was localized utilizing Veran technology and resected by Dr. Zaheer. In routine follow-up, a new nodule was discovered in the left lower lobe.

The patient was scanned in the left lateral decubitus position with Veran CT scan protocol. Upon reviewing the scan, the physicians noted the peripheral location of the nodule, at the distal section of the left lower lobe. In order to carefully avoid surrounding structures, navigation would be extremely important in this localization. Dr. Furukawa decided to dye mark the nodule using the 105mm SPiN Perc® introducer needle.

After a quick registration endobronchially, the procedure transitioned to SPiN Perc® for the localization. Dr. Furukawa first used the non-sterile SPiN Perc® stylet to line up his trajectory to the nodule. Thoracic surgeon Dr. Zaheer consulted with Dr. Furukawa to place the dye marking superior to the nodule to guide him to resect everything below the marking to ensure clean margins. He marked the specific spot on the skin to indicate his entry point and then prepped the area for the sterile procedure. During an expiratory breath hold, Dr. Furukawa advanced into the lung with the SPiN Perc® introducer needle and injected 0.3mL of dye superior to the nodule, and followed with 0.1mL to leave a trail to the chest wall. Dr. Zaheer began the surgery using VATS and was easily able to identify the markings on the chest wall and lung tissue to guide his resection line. He removed the wedge for immediate analysis by the pathology team. Pathology confirmed the presence of the nodule in the wedge with clean margins and a diagnosis of metastatic osteosarcoma. The accurate diagnostic wedge resection enabled the patient’s physician care team to quickly enact on a treatment plan.

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