Educational Exhibit Abstract No. 291 - “Visible but not palpable”: microcoil placement for localization of lung nodules prior to minimally invasive thoracoscopic surgery

Abstract

Learning Objectives 1. To understand the role of image guided lung nodule localization prior to video assisted thoracoscopic surgery (VATS). 2. To review the indications, technique, imaging findings, and complications of pre-operative microcoil placement for lung nodules. Background Lung cancer has the second highest incidence of malignancy and is the leading cause of cancer deaths in the United States. With improved imaging technologies there is an increasing detection of lung nodules that may benefit from early resection. Excision of these nodules utilizing VATS with robotic assistance is commonly performed, offering definitive pathological analysis and possibly better outcomes with minimal complications and speedy recovery times. Small nodules can be challenging to localize intra-operatively using palpation alone and preoperative localization using microcoils, needle/wire insertion or methylene blue/radiotracer injection may facilitate nodule localization during minimally invasive surgery. Clinical Findings/Procedure Details CT-guided percutaneous microcoil placement involves deployment of a microcoil through a needle such that a part of it is within or just beyond the nodule and the other end is located outside on the pleura surface. The pleural end of the coil is identified on the collapsed lung during surgery and serves as a guide to localize and selectively excise the nodule. The technique and steps of microcoil localization would be illustrated with images. Conclusion and/or Teaching Points Preoperative image guided localization of lung nodules plays a significant role in facilitating intra-operative localization during minimally invasive thoracoscopic surgery. After reviewing this exhibit, the attendee will be able to understand the indications, techniques of microcoil placement and other available alternatives for pre-operative lung nodule localization.