Open Resection of Multiple Pulmonary Metastasis Using the LEONARDO® Dual Wave 200W Laser System

Laser-assisted metastatectomy is a safe and validated technique for facilitating the resection of a large number of pulmonary metastases whilst maximizing lung tissue preservation (1). Here the authors present an open laser-assisted metastatectomy using the LEONARDO® Dual Wave 200W laser system, which is the first time this device has been used in the UK. The case in question is a 73-year-old man with a past history of duodenal carcinoma resected four years previously via the Whipple's procedure. Surveillance CT imaging revealed four enlarging right pulmonary nodules suspicious for metastatic disease. This was a trainee-led procedure performed by a standard posterolateral thoracotomy. An area of emphysematous lung was found incidentally at the apex, which was densely adherent to the chest wall and required partial decortication to fully mobilize. The procedure was performed without complication. An air leak was identified at the decortication site and this was oversewn with good effect at the end of the case. The patient developed a postoperative air leak which appeared to improve initially. However, on switching to an ambulatory flutter-valve bag, there was worsening surgical emphysema. Return to the theatre on postoperative day 12 revealed a persistent air leak from the decortication area, which was repaired. The patient subsequently made a good recovery and was discharged on postoperative day 17. Histology confirmed metastatic duodenal carcinoma.

Reference

1. Panagiotopoulos N, Patrini D, Lawrence D, Scarci M, Mitsos S. Pulmonary metastasectomy and laser-assisted resection. J Thorac Dis. 2018;10(Suppl 17):S1930–S1933.

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