Sant Pau launches a pioneering procedure in Europe for the extraction of a pulmonary nodule

An ovation breaks the silence in the operating room area of ​​the Sant Pau hospital, in Barcelona. A team headed by Juan Carlos Trujillo, head of Thoracic Surgery, has just carried out a pioneering operation in Europe: the detection, marking and extraction of a pulmonary nodule in a single intervention.

The loud applause comes from a large multidisciplinary group of professionals who have acted with precise synchronization on a patient who will be recovered in several weeks.

“What we have done is simplify the circuit, the fusion in the same act of two techniques that are done separately,” explains Dr. Trujillo at the end of the intervention. “Until now, patients had to come the day before or the same day to have a CT scan done and be able to apply the radiotracer to mark the pulmonary nodule. Then you had to wait until you entered the operating room to perform the resection.”

Using the new technique, with the patient sedated and intubated in the operating room, the diagnosis is made, the nodule is marked with a dye that will allow the surgeons to visualize the lesion, and the extirpation.

The first phase consists of performing a bronchoscopy using bronchial electromagnetic navigation, which allows access to the pulmonary nodule through a previously planned route. This procedure offers greater diagnostic yield than conventional bronchoscopy for detecting pulmonary lesions suspicious for malignancy.

The next act is the marking of the lesion, in this case, double. “A labeling with a fluorescent green dye that will allow thoracic surgery colleagues to visualize the lesion, and a labeling with a radiotracer, which will allow a gamma camera to be used to accurately locate the margins of the lesion,” explains pulmonologist Virginia Pajares, coordinator of the hospital’s bronchoscopy unit.

With the nodule located and doubly marked, everything is ready for the thoracic surgeons to enter the scene. Trujillo will use the Da Vinci robot, “a minimally invasive technique that reduces the patient’s morbidity and mortality and speeds up their recovery.”

Advantages of the new procedure? “We are reducing the morbidity that we add to our patients with the operation”, sums up the surgeon. “We are adding the best quality when it comes to diagnosis and treatment in the same act. The patient does not have to go through double anesthesia, they do not have to change areas within the hospital and at the same time we are sure that it is the best possible treatment”.

Enric Gotanegra accepted the proposal to undergo the pioneering procedure. He underwent surgery on a Tuesday, March 21, and on Friday he was already at home. Since then, the specialists at Sant Pau have performed five other similar procedures. “Everything is faster and much less aggressive”, explains the patient. Perfectly recovered, his condition is proof of the benefits of unifying the phases of therapy and increasing the precision of diagnosis and surgery.

According to Trujillo, it is the precision of the diagnosis and localization that allows the use of minimally invasive techniques in surgery and compensates for the loss of tact that they imply for the surgeon. “One of the novelties in lung cancer is that in nodules smaller than 2 cm, a subglobal resection, inferior to lobectomy, can be just as therapeutic. But it is not easy to put it into practice. These techniques allow us to be sure, on the one hand, that the resection is removing the lesion, be it malignant or benign, and, on the other, that the cut margins are correct.”

If a similar procedure had not been practiced before in Europe, it is because it is not easy to merge such novel techniques as electromagnetic bronchial navigation technology and robotic surgery and the equipment that manages them.

Professionals from the Pneumology and Allergy services (responsible for endobronchial navigation and double marking), Thoracic Surgery and Nursing, Anesthesiology, Diagnostic Imaging and Nuclear Medicine have participated. “The side-by-side work of the teams both beforehand and in the operating room has been essential, and in the end, the person who benefits the most from this close collaboration is the patient,” concludes Dr. Trujillo.