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Respiratory Gating Key in Accurately Localizing 6mm Nodule

LOCALIZATION OF NODULE WITH RESPIRATORY MOTION OF 3.4CM
Author
Dr. Jenifer Marks

Cardiothoracic Surgeon

The Medical Center of Aurora

Aurora, CO

Patient Information: 79 y/o, M

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RLL 6mm

Target Motion: 3.4cm

Biopsy Result: Sarcoma

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

Conclusion: Follow-up Chemotherapy

Observations

“The Veran system allowed me to efficiently localize and remove a 6mm nodule in the RLL that I would not otherwise have been able to remove without a larger incision. Obtaining a diagnosis on this lesion will allow for treatment now rather than having to wait and allow the nodule to enlarge. The dye was within about 2mm of the nodule, which is amazing considering how much our lungs move with each breath.”

Patient History
This patient had a previous history of sarcoma of the left lower extremity. During a CT scan several months ago, a few small lung nodules less than a few millimeters were discovered. The next follow-up CT scan showed the nodules were enlarging, now all within the 4mm-6mm range. Dr. Marks decided a surgical biopsy of the largest nodule was needed to obtain a diagnosis. As she knew she would not be able to palpate the nodule, Dr. Marks planned to use Veran for localization.

Planning
The patient was scanned in the lateral decubitus position using Veran CT scan protocol. Upon reviewing the CT scan, Dr. Marks identified and segmented the 6mm nodule in the RLL using Veran SPiN PlanningTM software. Respiratory gating would be key in this procedure, as the planning software noted movement of 34mm with each respiratory cycle. Dr. Marks planned a trajectory to reach the nodule percutaneously using the SPiN PercTM 1cm Localization Needle.

Procedure
Dr. Marks first used the Always-On Tip Tracked® Forceps to perform endobronchial registration with the patient in the lateral decubitus position, already positioned for surgery. The procedure then transitioned to SPiN PercTM for percutaneous localization. Dr. Marks lined up her trajectory to place a dye marking adjacent to the nodule, and advanced the needle into the nodule. Upon the start of the VATS procedure, Dr. Marks resected a wedge containing the dye mark. Pathology was able to confirm the presence of the small nodule in the wedge with a diagnosis of sarcoma with clean margins. The accurate localization enabled Dr. Marks to obtain a diagnosis for this patient, rather than having to wait and allow the nodule to enlarge before a diagnostic procedure could be performed. The patient’s care team was able to immediately plan a course of treatment.

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