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Veran Helps Achieve Diagnosis After Inconclusive CT-Guided Procedure

LOCALIZATION & RESECTION OF 11MM NODULE
Author
Dr. Ciaran McNamee

Thoracic Surgeon

Brigham & Women’s Hospital & Medical Center

Boston, MA

Patient Information: 46 y/o, F

Scan Protocol: Veran Inspiration/Expiration CT Scan Protocol

Nodule: RLL 11mm

Biopsy Result: Benign Granuloma

Instruments Used: Always-On Tip Tracked® Forceps & SPiN Perc™ Kit

Conclusion: Idiopathic Pulmonary Fibrosis

Observations

“Given this patient’s risk factors and history, I needed to get an accurate biopsy of this nodule. Veran helps me easily localize these smaller nodules which I would not be able to palpate during surgery.”

Patient History
This patient has a history of smoking and presented with a suspicious nodule in the right lower lobe. The nodule was first biopsied in a CT-guided procedure, where pathological results on the tissue came back inconclusive. Dr. McNamee needed to get an answer for this patient, given her risk factors and history, and decided to perform a diagnostic wedge resection.

Planning
The patient was scanned in the lateral decubitus position using Veran CT scan protocol. Upon reviewing the CT scan, thoracic surgeon Dr. McNamee identified and segmented the 11mm nodule in the RLL using Veran SPiN Planning™ software. There was roughly 51mm distance from the skin to center of the lesion. Dr. McNamee planned a trajectory to reach the nodule percutaneously using the SPiN Perc™ introducer needle.

Procedure
Dr. McNamee first used the Always-On Tip Tracked® Forceps to perform endobronchial registration with the patient in the supine position. The procedure then transitioned to SPiN Perc™ for percutaneous localization. Dr. McNamee lined up his trajectory and advanced the needle into the nodule. He then inserted a hook wire through the barrel of the introducer needle to mark the nodule. Upon the start of the VATS procedure, Dr. McNamee resected a wedge containing the hook wire. ROSE was able to confirm the presence of the small nodule in the wedge, a benign granuloma, with clean margins. Due to the successful localization, Dr. McNamee did not have to perform a diagnostic lobectomy. The benign diagnosis with negative margins allowed Dr. McNamee to finally get an answer for this patient and preserve healthy lung tissue.

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