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International Society For Minimally Invasive Cardiothoracic Surgery

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In Situ 3dct Guided Limited Lung Resection In The Hybrid Suite For A Pulmonary Nodule
Anna G. Everding, Hector R. Diaz, Benigno Ferreira, Aureliano Gutierrez, Carlos A. Jimenez.
Instituto Cardiovascular de Minima Invasion, Zapopan, Mexico.

BACKGROUND: Image guide interventions are especially complex in dynamic organs such as the lung. Minimally invasive approaches require a very exhaustive surgical planning, secondary to the limited surgical field. Live CT in hybrid operating room becomes a very helpful tool for the detection of small lung lesions (<3 cm) and its resection planification, giving an anatomical image of the thoracic cage, helping for determining the incision site and giving a precise location for the lesion with a sensitivity of 92.1%, specificity 100% and accuracy 92.1%, higher than with ultrasound, being able to be performed before, during and after the procedure, all at the surgical room. METHODS: 61 years old female diagnosed with Li Fraumeni Syndrome and history of brest Ca detected 2008, left lobectomy 2010 and radical mastectomy on 2011. She presents nodular lesion on the right apical pulmonary lobe. Planification of the nodular resection was made with Needle Guide Software from Artis Pheno device an the hybrid operating room. A 3D anatomic map was made. The needle is placed and adjusted its trajectory pinpointing the nodule. Trhough 3D guided thoracosopic vision, the marking zone is reached, performing a limited lung resection with endoscopic stapler. RESULTS: CT control was made at the hybrid operating room, showing no evidence of lung nodule. Hospital discharge was the day after the intervention, without complications. The sample was sent to histopathological study, reporting adenocarcinoma with predominant acinar type, allowing for further diagnostic work up and oncologic treatment. CONCLUSION: The CT 3D with needle guide represents an innovative technology, converting the minimally approaches more precise and secure, permitting the conservation of the healthy tissue, especially important in patients with previous procedures or in case of vital organs.


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