Percutaneous Localization: Open-label Registry of Thoracic Surgery

Study Overview
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Brief Summary
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The objectives of this study are to evaluate intraoperative percutaneous lung lesion marking assisted by electromagnetic guided percutaneous navigation and related tools.

Detailed Description
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The Intraoperative, Percutaneous Localization of Peripheral Pulmonary Nodules for Resection: a Prospective, Open-Label, Multi-Center Registry Study of Thoracic Surgery Outcomes (PLOTS) registry is aimed at developing a high quality set of data regarding intraoperative percutaneous localization of peripheral pulmonary nodules (PPNs), and then identifying and promulgating efficient, evidence-based best practices for this technique. The resection procedure itself is standard of care and follows the investigator's standard protocol. Successful localization of PPNs is a challenge involving multiple factors, beginning with the subjects' health, lung function and also factors specific to the nodule including location within the lung, size, distance from the lung surface, whether solid or ground glass and proximity to a fissure. Hard to see or palpate nodules are currently localized with dye and/or hook wires or fiducials, either endoscopically or percutaneously. Successful, large, prospective studies have not been reported using modern electro-magnetic navigation (EMN)-guided percutaneous intraoperative localization, and different techniques (dye vs. fiducial vs. hook wire etc.) have not been broadly evaluated. It is for these reasons that the different localization techniques used with EMN-guided percutaneous localization will be collected for patients having a suspicious nodule and who undergo percutaneous intra-operative localization and immediate resection. This registry aims to record the localization techniques used by thoracic surgeons and IP/surgical teams to identify PPNs using the SPiN Thoracic Navigation System™ in the hands of trained physicians. The objectives of this study will be to accomplish the primary and secondary objectives listed below, and to observe localization in a real world context of pulmonary resection.

Official Title
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Intraoperative, Percutaneous Localization of Peripheral Pulmonary Nodules for Resection: a Prospective, Open-Label, Multi-Center Registry Study of Thoracic Surgery Outcomes.

Conditions
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Lung Lesion(s) Requiring Evaluation, Pulmonary Metastasis, Pulmonary Nodule, Solitary, Peripheral Lung Lesions

Intervention / Treatment
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* Procedure: Percutaneous localization of suspicious lung lesion(s) using electromagnetic navigation and tools.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subject's physician and/or thoracic surgeon have deemed/has deemed that the surgical removal of the PPN is appropriate. A clinical decision has been made to use the SPiN Thoracic Navigation System™. Subject is at least 18 years of age at time of study entry. Subject is able to read, understand, and voluntarily sign the IRB-approved informed consent document prior to the performance of any study-specific procedures. IRB- approved translation may be used if indicated. Reasonable accommodation of visually impaired subjects will be allowed. Subject is able to tolerate general anesthesia. Subject has a target nodule between 0.4 cm and 3.2 cm in greatest dimension; The target nodule is in a location that is accessible for percutaneous localization in the judgement of the surgeon. Exclusion Criteria: Subjects with any other concomitant treatment or medical condition that, in the opinion of the clinician, would render peripheral nodule resection more hazardous than beneficial. Subject is pregnant. Pulmonary nodule is greater than 3.2 cm. Subjects with significant coagulopathy having INR > 2.0 or PTT > 2x normal. Subject is unable to tolerate general anesthesia. Obese subject, impacting percutaneous access (BMI > 50).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Localization<br>Electromagnetic navigation (EMN) guided percutaneous localization of suspicious lung lesion(s). | Procedure: Percutaneous localization of suspicious lung lesion(s) using electromagnetic navigation and tools.<br>* Transthoracic localization of suspicious lung lesion(s) in preparation for subsequent resection.<br>* Other names: Veran System;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of successful percutaneous localization and removal of PPN. | Successful percutaneous localization of PPN defined as the percentage of subjects in whom the nodule is successfully localized and removed in the first resected specimen. | Duration of procedure. | 
| Collect safety data for localization procedure. |  | Duration of procedure. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Report localization method and technique. | Details regarding the localization technique will be collected, including the materials used. If dye (methylene blue, ICG etc.) is used the volume will be collected. Other materials include microcoils, hook wires, etc.. | Duration of procedure. | 
| Collect data on intraoperative percutaneous localization time and duration of total surgical procedure. | The time of the localization procedure will be recorded. The length of the entire surgical procedure will also be recorded. | Duration of procedure. | 
| Record nodule characteristics, including location in the lobe, distance from pleura, distance from surface of skin to target, morphological appearance, solid vs. ground glass etc. |  | Duration of procedure. | 
| Record weight of excised tissue and margin. |  | Duration of procedure. | 
| Report type of surgical resection performed and the resection technique used. | The surgical resection may include segmentectomy or wedge using the VATS, RATS, or thoracotomy techniques. | Duration of procedure. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Surgical Lung Resection, Percutaneous Localization, Electromagnetic Navigation, Transthoracic Localization, Peripheral Pulmonary Nodule(s)