A surgical biopsy of the lung is a common operation.
A biopsy may be needed for a variety of reasons. One of the most common reasons for a surgical lung biopsy is a suspicion of interstitial lung disease.
Interstitial lung disease (ILD) is a broad term which encompasses disorders which affect the interstitium, the space around the air sacs.
In general, ILD is more of a descriptive term than a specific diagnosis. In fact, ILD may be caused by a number of conditions.
Causes of ILD include:
--- Idiopathic pulmonary fibrosis
--- Medications, such as amiodarone, chemotherapy
Usually, ILD is associated with symptoms such as shortness of breath, cough, and tiredness. It is also associated with abnormal findings on imaging, reduced lung function on objective testing, and inflammatory cells on a microscopic level.
In general, ILD is related to injury to lung and the body's response to the injury. The response involves scarring, which is a prominent feature of ILD. The scarring leads to impaired exchange of oxygen and carbon dioxide in the lungs. Scarring is known as fibrosis.
A common scenario is that a patient develops shortness of breath or cough. Antibiotics are given. The patient does not improve. The patient consults a pulmonologist. A scan shows thickened lung tissue. If the patient worsens or the scan shows severe thickening, a lung biopsy may be needed, in order to help determine the cause of the interstitial lung disease.
Sometimes ILD is progressive and permanent; some patients may ultimately need lung transplantation. Some cases are reversible. A biopsy may help determine if therapy can be given to help slow or reverse the process.
In many cases of ILD, both lungs are affected. Some portions of the lungs may be more severely affected than others.
When it comes to a biopsy for ILD, generally one lung is biopsied. An assumption is made that whatever process is affecting one lung is affecting the other; this assumption is considered valid for almost all patients.
If the lung has a nodule or mass, a percutaneous biopsy can often be used to obtain the diagnosis. A percutaneous biopsy is performed thru the skin, with a needle.
However, in cases of ILD, a percutaneous biopsy is not usually helpful. This is because the samples taken with a needle technique are very small and not usually sufficient for extensive testing.
Dr. Pool uses the daVinci robot for almost all of the lung biopsies he performs.
Robotic lung biopsy is performed with a general anesthetic.
The 10X magnification of the robot camera allows for excellent visualization of the lung and thoracic anatomy.
The lung is carefully inspected for abnormal areas. Often the lung looks inflamed and reddened.
A robotic stapler is used to remove small pieces of lung, which are sent to the pathologist for study. The specimens will be tested for bacteria and fungi and microscopic features.
Dr. Pool usually performs robotic lung biopsy on the right side, since the heart is slightly out of the way, unless the left lung looks worse.
Robotic lung biopsy usually takes Dr. Pool about an hour to perform.
A drainage tube is inserted at the end of a robotic blebectomy.
Most patients go home the day after robotic lung biopsy, after the drainage tube is removed.
Dr. Pool has performed many robotic lung biopsies.