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International Society For Minimally Invasive Cardiothoracic Surgery

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Techniques For Localization Of A Lung Lesion Using Navigational Bronchoscopy
Andrew R. Brownlee, MD, Amirhossein P. Mahfoozi, MD, Taryne A. Imai, Harmik J. Soukiasian, MD.
Cedars-Sinai Medical Center, Los angeles, CA, USA.

BACKGROUND:
Bronchoscopy is a preferred method for sampling suspicious pulmonary lesions given the low complication rate as well as the potential for performing mediastinal staging at the same time, when indicated. Robotic navigational bronchoscopy has been shown to improve diagnostic yield for the sampling of peripheral lung nodules. This technology can be limited by the differences between the CT scan and the real time anatomy (CT to body divergence). As such, additional techniques are required in order to augment the efficacy of this technology.
METHODS: In this video we provide a clinical vignette of an unusual case and use it to highlight varied approaches to navigation to peripheral lung lesions, the confirmation of location and biopsy.
RESULTS:
This video shows the case of a 54-year-old female with a 2-year history of pleuritic chest pain. She was found to have a peripheral lung lesion on CT chest. We demonstrate the use of robotic navigational technology, die marking with indocyanine green and methylene blue, as well as the use of radial EBUS to improve diagnostic yield. The case described resulted in a diagnosis of cryptococcal pneumonia, thus mitigating the need for surgical intervention. The patient was discharged the same day.
CONCLUSIONS: Successful robotic navigational bronchoscopy can be augmented by using a multimodal approach to navigation, confirmation of location as well as biopsy.


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