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Successful Localization Assists in Ruling Out Metastatic Disease

DIAGNOSTIC WEDGE RESECTION OF RLL NODULE
Author
Dr. J. Matthew Reinersman, MD FACS

Assistant Professor, Division of Thoracic and Cardiovascular Surgery

University of Oklahoma Health Sciences Center

Oklahoma City, OK

Patient Information: 75 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RLL 7mm

Biopsy Result: Benign

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

Conclusion: Intraparenchymal lymph node; continued chemotherapy for primary pancreatic cancer

Observations

“Using the Veran SPiN Perc™ technology to localize small nodules is a game-changer. This process is smooth, quick and accurate, obviating the need for IR localization or hybrid OR, and consolidating the procedure. This allows for accurate and fast diagnosis and treatment of nodules we used to follow with serial scans.”

Patient History
The patient is a 75 year old female found to have a pancreatic head mass with a biopsy proven to be pancreatic adenocarcinoma. She planned to go through neoadjuvant chemotherapy prior to a planned Whipple procedure. CT imaging prior to the procedure revealed an enlarging right lower lobe lung nodule, which grew from 4 x 2 mm to 7 x 4 mm over a few months. The patient was referred for biopsy or resection due to the concern for metastatic disease.

Planning
Dr. Reinersman used the Veran SPiN Planning™ software to create a plan to target the 7 mm nodule in the RLL with a percutaneous approach. He also planned an entry point for the SPiN Perc™ 1 cm Localization needle he planned to use for dye injection to mark the nodule.

Procedure
The patient was brought into the OR, intubated, and then turned in the left lateral decubitus position for localization and resection. Dr. Reinersman first performed an airway inspection and registration using a slim bronchoscope and the Always-On Tip Tracked® Forceps. The procedure then transitioned to SPiN Perc™. Dr. Reinersman lined up the localization needle with his entry point, and advanced the needle through the chest wall to the target. As he visualized the needle ports on the Veran system, Dr. Reinersman injected 0.6cc of dye into the nodule. The patient was then prepped and draped for thoracoscopy. The dye marking was easily identified on the right lower lobe. Dr. Reinersman completed a wedge resection containing the dye, and pathology confirmed the presence of the nodule. Final pathology revealed the nodule to be a benign intraparenchymal lymph node with a focus of osseous metaplasia and no evidence of malignancy. This successful diagnostic wedge resection allowed the patient to quickly continue their planned chemotherapy and receive potentially curative resection.

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