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3-Dimensional Reconstruction for Resection of a Growing Lung Nodule
John P. Costello, MD1, Dilip S. Nath, MD2, Hank P. Rappaport, MD3, M. B. Marshall1.
1MedStar Georgetown University Hospital, Washington, DC, USA, 2Children's National Medical Center, Washington, DC, USA, 3MedStar Center for Innovation, Washington, DC, USA.

OBJECTIVE: We created this video to demonstrate the use 3- dimensional reconstruction as well as tissue sealing devices for the resection of a growing central hamartoma without parenchymal resection.
METHODS: A 42 year old male was found to have a right upper lobe nodule. This was unchanged in size for 7 years but began to grow, prompting referral for biopsy and subsequent resection. Given the diagnosis of a hamartoma, the patient, a lawyer, requested the least amount of parenchyma removed as possible. His DICOM files were loaded into 3 dimensional modeling software and used to create a three-dimensional model. The images and model were studied to create a minimally vascular path from the hilum to the lesion.
RESULTS: A minimally invasive approach was used with 5 mm and 3 mm ports, pediatric laparoscopic instruments and a 5mm 30 degree camera. The nodule was enucleated. There was a minimal air leak at the completion of the procedure. Fibrin sealant was used on the parenchymal laceration. Intercostal blocks were placed. The air leak resolved by the first postoperative day and the chest tube was removed. The patient was discharged on the second postoperative day. He used no additional pain medication in the hospital or after discharge.
CONCLUSIONS: Three-dimensional imaging can be useful for operative planning. Deep benign lesions may be excised without parenchymal resection. Air leaks in patients with normal parenchyma do not appear to be problematic with the use of sealing devices and fibrin sealants. Multiple VATS ports can be associated with minimal pain.

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