Dr. Mohammed Al-Halawani
Pulmonologist
Hutchinson Regional Medical Center
Hutchinson, KS
Patient Information: 70 y/o, M
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Target: 2cm Rib fragment on left 4th Rib
Target Motion: 0.8mm
Biopsy Result: Localized Rib Fracture
Instruments Used: SPiN Perc® Introducer Needle and Always-On Tip Tracked® Forceps
Conclusion: Removal of bone fragment
“Not only did it help us minimize time in the OR and time that the patient was under anesthesia, but it also made it significantly easier for the localization of the rib fragment that was embedded in the lung parenchyma.”
Patient History
This 70-year-old male patient has a past medical history of coronary artery disease and was admitted to the hospital after having a mechanical fall in his bathroom with trauma to the left side of his chest. He sustained multiple rib fractures and was found to have a hemothorax. His trauma was further complicated by a 2cm rib fragment on his 4th rib, which was displaced centrally with the fragment protruding into the adjacent lung. Pulmonary and CT surgery services were consulted on the case for evaluation of his rib fractures and management of the rib fragment. It was agreed upon that the displaced rib imposes a risk of puncturing the lung and potentially causing bronchopleural fistula.
Planning
A joint procedure was planned to mark and remove the rib fragment. The physician made the decision to perform such combined procedure using the Veran navigation system. On the day of the procedure, the patient underwent a same-day, respiratory gated CT scan to map the target using the SPiN Planning® software. Dr. Al-Halawani continued planning by using the software to identify the appropriate external entry point with the most direct pathway to the area of interest.
Procedure
After planning was complete, Dr. Al-Halawani used the SPiN Drive® software to automatically register the patient’s real-time anatomy to the same-day CT images using the Always-On Tip Tracked® Forceps. After a quick prep for the procedure, Dr. Al-Halawani waited for respiratory gating to match before the SPiN Perc® introducer needle was advanced percutaneously with the guidance of the SPiN Thoracic Navigation System®. Once the target was reached, 2mL of dye was injected into the planned target portion of the rib fragment to localize the area for surgical removal. Upon retraction of the needle, an additional amount of dye was used to create a trail from the rib fragment to the skin. Video-assisted thoracoscopic (VATS) surgery was used to access the area of interest, which was easily visualized after localization. Upon surgical inspection, it was found that a bone fragment was protruding into the chest cavity, injuring the lung parenchyma. The fragment was then removed using a clamp, and a chest tube was placed. The patient was discharged a few days later to a subacute rehab facility for recovery.
