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BackTable / VI / Podcast / Episode #278

Minimizing Complications for Lung Biopsies

with Dr. Robert Suh

In this episode, host Dr. Chris Beck interviews chest and interventional radiologist Dr. Robert Suh about his lung biopsy technique, including how he approaches pain management, and his take on the best way to seal the biopsy tract to prevent air leaks.

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Minimizing Complications for Lung Biopsies with Dr. Robert Suh on the BackTable VI Podcast)
Ep 278 Minimizing Complications for Lung Biopsies with Dr. Robert Suh
00:00 / 01:04

BackTable, LLC (Producer). (2023, January 3). Ep. 278 – Minimizing Complications for Lung Biopsies [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Robert Suh discusses Minimizing Complications for Lung Biopsies on the BackTable 278 Podcast

Dr. Robert Suh

Dr. Robert Suh is a chest radiologist and interventional radiologist with UCLA in California.

Dr. Christopher Beck discusses Minimizing Complications for Lung Biopsies on the BackTable 278 Podcast

Dr. Christopher Beck

Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.

Show Notes

Dr. Suh begins by telling us about his background and current practice at UCLA. He was trained in interventional radiology but did a second fellowship in chest radiology due to the job market at the time. At UCLA they have a very organ-specific practice, and Dr. Suh has spent his whole career on chest and lung imaging and procedures. He splits his time between procedures, triage and planning, clinic and administrative days.

Before a lung biopsy, Dr. Suh sees the patient when they arrive and reviews their procedure. He ends the patient meeting by putting the ball back into their court by coaching them on their breathing. He tells them to take a small breath in and hold it. He has them concentrate on this while on the table which gives them more control in an unfamiliar environment. He uses mild or moderate sedation, and feels that the most important part of pain management is properly numbing the parietal pleura as it is somatically innervated. To do this, he brings a 19 gauge coaxial needle up to the extrapleural space, which looks like a black band of fat, and administers at least 10cc of lidocaine or bupivacaine. Once the parietal pleura is numb, the procedure goes much better because the needle is not tugging on the pleura with each breath. For subpleural lesions, he prefers a tangential approach, which crosses more lung parenchyma but yields a better sample than the shorter perpendicular approach. If a target is inaccessible, he first tries to reposition the patient and does not hesitate to consult interventional pulmonology to discuss alternative approaches.

Dr. Suh discusses how he previously used blood patches at the end of the biopsy to seal the tract, and why he changed his technique. He now exclusively uses BioSentry, a hydrogel polymer that functions similarly to a blood patch. After deploying the BioSentry through the introducer needle he waits 3-5 minutes, checks for pneumothorax development, and if there is no pneumothorax he sends patients home within 30 minutes without doing a post-biopsy chest x-ray.

Resources

Transcript Preview

[Dr. Robert Suh]
So I think the first thing is you look at the board and what's going on and go through the cases. Sometimes we have residents and fellows as you can imagine. It's important to sit down and go through the target and the needs of the patient and the procedure, and then when I see the patient, it's really just running through the procedure, just what they're going to expect, and then I'd like to conclude that with maybe some expectations that I have for them in that I think one of the keys to have a successful procedure, and especially a lung biopsy, is to put the ball back into the patient's court, so to speak, so that they feel like that they have some sort of skin in the game.

So one of the last things I lead with is I ask them if they remember when they had their CAT scan or PET scan and if they remember that they took a big breath in and held it. Usually, they go, "Yeah, yeah, I remember that happened,” and I go, "Here, we just want you to take a small comfortable breath." Something that whether I ask them or our fellow or our technologist, just try to do it the same way each time. I think in many cases that sort of takes the, I guess the nervousness or the anxiety from the procedure because when they're laying, they're on the table, they're concentrating on something else and focusing on trying to do something else.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Topics

Lung Biopsy Procedure
Lung Cancer Condition Overview
Pneumothorax Condition Overview

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