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Precise Localization Helps Preserve Healthy Lung Tissue

DIAGNOSTIC RESECTION OF RLL NODULE
Author
Dr. Galen Ohnmacht

Chief of Thoracic Surgery

University of Maryland

Baltimore Washington Medical Center

Glen Burnie, MD

Patient Information: 66 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RLL 24mm

Target Motion: 35mm

Biopsy Result: Benign

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

Conclusion: Benign granuloma

Observations

“The dye marking was spot-on accurate to the location of the nodule. This enabled me to take the smallest wedge of tissue possible from the patient for pathology to call a diagnosis.”

Patient History
This patient presented with abdominal pain. A diagnostic CT scan revealed a pulmonary nodule in the right lower lobe. After follow-up visit several weeks later, the nodule appeared to grow in size on CT-imaging and looked highly suspicious on a PET scan. Due to the suspicion of malignancy, the patient was referred to Dr. Ohnmacht for a diagnostic surgical resection.

Planning
Upon review of the CT scan, Dr. Ohnmacht made a plan to reach the target percutaneously from a lateral approach. Based on location and depth, it was determined the 1cm SPiN Perc™ Localization needle was necessary to reach and mark for resection. A trajectory was planned in between two ribs and to avoid fissures. The planning process took roughly 5 minutes.

Procedure
Dr. Ohnmacht completed initial registration using Always-On Tip Tracked® forceps to check main and secondary carinas and then transitioned to Spin Perc™ for the localization. After lining up his trajectory, he used the 1cm SPiN Perc™ Localization Needle to navigate to the target and steadily inject 0.5mL of dye into the target. Dr. Ohnmacht transitioned into the surgical resection to remove the nodule for diagnosis. The dye marking was easily visible on the lung. Dr. Ohnmacht removed a small wedge containing the dye marking for the onsite pathology team. Pathology confirmed the presence of the nodule and a benign diagnosis of granuloma. The procedure concluded at this point with the answer of a benign diagnosis. Due to the accurate localization, Dr. Ohnmacht was able to get a diagnosis by resecting the least amount of healthy lung tissue and spare the patient from a diagnostic lobectomy.

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