T-fasteners for Preoperative Localization of Pulmonary Nodules

A 19 year-old male who presented with a persistent cough for three years was found to have multiple pulmonary nodules on imaging. A tissue diagnosis was necessary to determine the etiology of these nodules. Wedge resection of a peripheral nodule via video-assisted thoracoscopic surgery was planned. Pre-operative localization of this nodule was accomplished using a novel method of cone beam computed tomography and fluoroscopy where in a T-fastener and methylene blue were inserted. This method was well tolerated by the patient, permitted easier transport and positioning of the patient preoperatively, and allowed for clear identification of the nodule intraoperatively. In addition, the T-fastener is theoretically less traumatic to the lung than a traditional hook wire, and therefore less likely to cause a pneumothorax preoperatively. T-fasteners have been used extensively in the placement of gastrostomy tubes and this novel use of T-fasteners may be superior to current methods of preoperative pulmonary nodule localization.