Custom-Made Circular Clamp for Deep Located Lung Nodule Resection

Pulmonary metastases excision is indicated for lung-sparing resection of small and central lesions when wedge resection or segmentectomy are unfeasible. This procedure can be challenging in case of deep-located metastases due to the slippery aspect of the nodule, and potentially profuse lung tissue bleeding when an electric scalpel or laser devices are used. This video shows the use of a novel custom-built circular clamp for performing the resection of a uterine sarcoma metastasis of the upper left lobe. The clamp blocks and exposes the nodule, thereby avoiding parenchymal bleeding during the incision and allowing accurate suturing after the excision.

A 69-year-old woman affected by bilateral pulmonary metastases of a precedent endometrial sarcoma was a candidate for bilateral staged metastasecomy. Following a right inferior lobectomy and a right upper wedge resection, just before the left side surgery, the patient was infected with COVID-19, developing a mild respiratory syndrome. After two negative Sars-Cov tests and respiratory recovery, the patient underwent a left upper metastasis excision of the centrally located pulmonary nodule. Preoperative CT scan showed the deep under-pleural localization of the upper lobe’s lesion. A novel tailor-made circular clamp was used to perform the intervention. A lateral muscle-sparing thoracotomy was performed. After an explorative bimanual palpation of the whole lung, the lesion was detected in between the S2 and S4 segments. The circular clamp was thus positioned to target the nodule stabilizing lung parenchyma and avoiding the nodule’s sliding by clamping action of the two coaxial parallel rings. The lesion was excised using the electric knife with a high coagulative level leaving the nodule at the center of the resected circle. Parenchymal bleeding was drastically reduced as a result of the mechanical compression of the posterior plate disc of the clamp. Pneumotomy was then sutured by single stitches and polypropylene 3/0 running sutures. Finally, a single 24 Ch chest tube was placed and pulmonary re-expansion was checked. No intraoperative nor postoperative complications occurred and the chest tube was removed on postoperative day two.

Suggested Reading

1. Petrella F, Diotti C, Rimessi A, Spaggiari L. Pulmonary metastasectomy: an overview. J Thorac Dis. 2017;9(Suppl 12):S1291-S1298.
2. Petrella F, Leo F, Dos Santos NA, Veronesi G, Solli P, Borri A, et al. "Circular clamp" excision: a new technique for lung metastasectomy. J Thorac Cardiovasc Surg. 2009;138(1):244-245.

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