Dr. Po-Kuei Hsu
Thoracic Surgeon – Taipei Veterans General Hospital
Associate Professor – National Yang-Ming University
Taipei City, Taiwan
Patient Information: 61 y/o, F
Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol
Nodules: Three nodules; 8mm, 4mm & 3mm
Biopsy Result: Malignant
Instruments Used: Always-On Tip Tracked® 21ga Needle and SPiN Perc® Kit
Conclusion: Minimally invasive adenocarcinoma
“I first performed an endobronchial localization on the target which was accessible via an airway. Transthoracic localization was performed for the target nodule which was not accessible via bronchoscopy. This combined approach using the SPiN Thoracic Navigation System® can be a solution for patients with multiple nodules.”
Patient History
The patient is a 61-year-old female with no history of tobacco use. Through routine CT scans as part of a lung cancer screening program, a persistent 8mm ground glass nodule was discovered in the left lower lobe. She was referred to Dr. Hsu for a minimally invasive resection. Two additional GGO nodules, 4mm and 3mm, in the left lower lobe were also planned to be included in the resection procedure.
Planning
The patient was scanned in the lateral decubitus position using Veran CT scan protocol. Upon reviewing the CT scan, Dr. Hsu identified and marked the 3 GGO nodules in the left lower lobe using Veran SPiN Planning® software. He considered the location of each target, and accessibility via airway, to plan the best method of localization for each nodule. Dr. Hsu decided to proceed with endobronchial localization for the 8mm nodule, and percutaneous localization for the 4mm and 3mm nodules.
Procedure
In the OR, the patient was prepped in the thoracotomy position for localization and resection. After a quick endobronchial registration, Dr. Hsu navigated to the 8mm target with the Always-On Tip Tracked® 21ga needle. He advanced the tip of the needle through the target toward the visceral pleura and injected 0.3mL of dye to mark the location of the nodule. The procedure then transitioned to SPiN Perc® for percutaneous localization. Dr. Hsu lined up the SPiN Perc® introducer needle with his entry point and advanced the needle through the chest wall to the 3mm target. He injected 0.3mL of dye into the 3mm target, and repeated this for the second 4mm nodule. The surgical resection was performed via single port thoracoscopy. Dr. Hsu identified the 3 dye markings on the visceral pleura of the lung, and completed 3 wedge resections. All 3 diagnostic wedge resections contained the nodule of interest with an accurate dye marking. Final pathology concluded minimally invasive adenocarcinoma for the 8mm nodule and adenocarcinoma in situ for the 2 smaller nodules. Utilizing Veran for preoperative localization helped Dr. Hsu resect all 3 nodules quickly and with the least amount of lung tissue.
