Dr. Joseph Seaman
The patient is a 74 year old male with a 50 pack-year smoking history who was referred 18 months prior for an incidental 13mm RUL nodule. A work-up at that time showed low level PET activity. A navigation bronchoscopy was performed using legacy technology and was non-diagnostic. The patient was then referred for transthoracic needle biopsy and that procedure was also non-diagnostic. The nodule slowly grew to 15mm over the course of the next 18 months, and so a MONARCH® Bronchoscopy was scheduled to diagnose this nodule.
The nodule was located in the posterior RUL with no bronchus sign visible on CT. There appeared to be two blood vessels on either side of the nodule on axial CT (Fig.1). The navigation was difficult to optimize access to the nodule. The nodule was completely eccentric on R-EBUS on the initial approach. After using a biopsy needle to traverse the bronchial wall and access the lung parenchyma (Fig.2), the mini probe was passed through the bronchial wall and a concentric R-EBUS signal was visualized (Fig.3).
"The value of VISION the MONARCH® Platform provided me was something that lacked for two previously non-diagnostic procedures."
Using the MONARCH® Platform, I was able to visualize and plan my approach to access the target lesion. Once an optimal approach was created, we used the needle to traverse the bronchial wall and access the lung parenchyma. This approach allowed for access to the lesion and provided a diagnosis of adenocarcinoma. The value of VISION the MONARCH® allowed me was something that lacked for the two previously non-diagnostic procedures. With this diagnosis the patient will now be able to discuss personalized treatment options, instead of “watch and wait” as his nodule potentially continued to increase in size.
Dr. Seaman is an Interventional Pulmonologist at Sarasota Memorial Hospital in Sarasota, FL.
Indications for Use: The MONARCH® Platform and its accessories are intended to provide bronchoscopic visualization of and access to patient airways for diagnostic and therapeutic procedures.
Important Safety Statement: Complications from bronchoscopy are rare and most often minor, but if they occur, may include breathing difficulty, vocal cord spasm, hoarseness, slight fever, vomiting, dizziness, bronchial spasm, infection, low blood oxygen, bleeding from biopsied site, or an allergic reaction to medications. It is uncommon for patients to experience other more serious complications (for example, collapsed lung, respiratory failure, heart attack and/or cardiac arrhythmia).
This document reflects the techniques, approaches and opinions of the individual physician. This Auris sponsored document is not intended to be used as a training guide. Other physicians may employ different techniques. The steps demonstrated may not be the complete steps of the procedure. Individual physician preference and experience, as well as patient needs, may dictate variation in procedure steps. Before using any medical device, review all relevant package inserts with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device(s).
Dr Joseph Seaman is compensated by and writing on behalf of Auris Health and must present information in accordance with applicable FDA requirements.
Complications from bronchoscopy are rare and most often minor, but if they occur, may include breathing difficulty, vocal cord spasm, hoarseness, slight fever, vomiting, dizziness, bronchial spasm, infection, low blood oxygen, bleeding from biopsied site, or an allergic reaction to medications. Only rarely do patients experience other more serious complications (for example, collapsed lung, respiratory failure, heart attack and/or cardiac arrhythmia).
Adverse effects from both Mini-PCNL and Ureteroscopy include pain, urinary tract infection, fever, hematuria (presence of blood in urine), exposure to low levels of radiation, retained or residual stones.
Adverse effects from ureteroscopy may include pain, perforation or injury to the ureter, resulting in extravasation of fluid and urine (urinoma), stricture of the ureter with risk of subsequent obstruction (hydronephrosis needing further repair), rare avulsion of the ureter, urinary blood clots, residual stones.
PCNL access may result in minor and major adverse effects. Minor effects include fever and nephrostomy leak. Major adverse effects may include injuries to pleura, liver, spleen, large vessels with related bleeding, gallbladder, duodenum, jejunum, colon with related cutaneous fistula, fever, pain, ileus, elevated counts.
Major adverse effects related to stone removal may include infection and urosepsis, intravascular fluid overload, extravasation of fluid, and post percutaneous nephrolithotomy bleeding.