Missing lung nodule? Intra-operative contingency plan with O-arm imaging: a case report

Area of Science:

• Thoracic Surgery
• Surgical Imaging
• Pulmonary Medicine

Background:

• Minimally invasive thoracoscopic surgery for small, non-palpable pulmonary nodules faces localization challenges.
• Pre-operative localization methods increase time, cost, and complications.
• Intra-operative ultrasound has limitations in visualizing deep lesions and is operator-dependent.

Observation:

• A case report details the use of the O-arm Surgical Imaging System in an 81-year-old male patient with an 8 mm left lower lobe lung nodule.
• Two prior thoracoscopic wedge resections were unsuccessful in resecting the nodule.
• The O-arm system provided immediate 3D imaging feedback within the standard thoracoscopy room.

Findings:

• The O-arm system facilitated the successful resection of the previously missed lung nodule with negative margins.
• This imaging modality allowed for real-time intra-operative assessment, preventing the need for patient repositioning or conversion to thoracotomy.
• The O-arm proved effective in identifying the elusive nodule, avoiding a missed resection.

Implications:

• The O-arm Surgical Imaging System can enhance intra-operative localization accuracy for challenging pulmonary nodules.
• It offers a potential solution to improve success rates in thoracoscopic lung nodule resection.
• This technology can potentially transform standard thoracoscopy suites into hybrid operating rooms for complex cases.