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

Laser-assisted resection of pulmonary metastasis has been established for over a decade (1). A significant advantage over conventional wedge resection is the preservation of lung tissue, allowing resection of multiple and/or bilateral metastasis without compromising pulmonary function, whilst achieving similar survival and recurrence rates (2). The technique has since been adapted to the VATS setting. In this trainee-led procedure, the Leonardo® 200w dual wave laser system was used, the first use of this device for VATS metastatectomy in the UK. The case presented is a 56-year-old female who underwent an anterior resection for colorectal adenocarcinoma in 2018. A surveillance chest CT revealed three new pulmonary nodules, one in each of the right upper and lower lobes, and one in the left lower lobe. The largest one at 12mm was PET-avid. A right-sided operation was performed and both lesions were successfully excised. In this example, a small piece of tumor was initially left in the lower lobe resection bed, but this was recognized and resected. The patient made an uneventful recovery and was discharged on post-operative day 1. From our early experience, case selection for VATS metastatectomy is vitally important. Ideally 1 - 2 nodules should be present in a lateral position and should not be too deep or large (>1cm from the lung surface or >2cm in diameter). Where lesions are deep or large, longer periods of laser activation are required and smoke can build up within the chest cavity reducing vision. Therefore, repetitive pauses to allow the smoke evacuator to clear can prolong operative time.

References

1. Rolle A, Pereszlenyi A, Koch R, Bis B, Baier B. Laser resection technique and results of multiple lung metastasectomies using a new 1,318 nm Nd:YAG laser system. Lasers Surg Med. 2006 Jan;38(1):26-32. doi: 10.1002/lsm.20259. PMID: 16444696.
2. 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. doi:10.21037/jtd.2018.05.08

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