The usefulness of preoperative colonoscopic tattooing using a saline test injection method with prepackaged sterile India ink for localization in laparoscopic colorectal surgery

Preoperative tumor marking with indocyanine green (ICG) prior to minimally invasive colorectal cancer: a systematic review of current literature

Aim

To describe the currently available evidence regarding the efficacy and safety of preoperative tumor marking using indocyanine green (ICG) prior to laparoscopic or robotic colorectal resections.

Methods

A systematic search for relevant studies was conducted using the following databases: Embase (OVID), MEDLINE® (OVID), APA PsycInfo (OVID), Global Health (OVID) and HMIC Health Management Information Consortium (OVID) through June 2022 reported according to PRISMA 2020 guidelines. Primary outcome was the detection rate of the tumor sites preoperatively marked with ICG. Secondary outcomes were timing of ICG injection in days prior to the operation and technique-related complications.

Results

Eight single center studies, published between 2008 and 2022, were identified yielding a total of 1,061 patients, of whom 696 were preoperatively tattooed with ICG. Injection dosage of diluted ICG ranged from 0.1-1.5 ml. Four studies used the saline test injection method prior to ICG injection. When the marking was placed within one week, the visualization rate was 650/668 (97%), whereas when it was longer than one week, the detection rate was 8/56 (14%). No severe complications were reported.

Conclusion

Preoperative tumor marking using ICG prior to minimally invasive colorectal resections is safe and effective, allowing intraoperative tumor site location when performed up to a week prior to surgery without disturbing the surgical view in potential mild complications.

The Accuracy of Different Modalities Used for Preoperative Primary Tumour Localisation in Operated Colorectal Cancer Patients

Aim Colonoscopy and computed tomography (CT) scans of the abdomen and pelvis are routine pre-operative assessment tools in colorectal cancer (CRC) patients. There have been some discrepancies regarding the location of cancer when seen by colonoscopy versus CT scan. The purpose of this study was to compare the accuracy of a colonoscopy with a computed tomography (CT) scan of the abdomen and pelvis with contrast, which is done routinely before surgery to localise the exact site of the tumour within the large bowel, whilst comparing both to the operative, gross and histopathology findings of the exact location. Methods A retrospective study was carried out on 165 colorectal cancer patients operated on between January 1, 2010, and December 31, 2014, using electronic hospital records that were reviewed anonymously, comparing the location of cancer within the large bowels as was found on colonoscopy and CT scan of the abdomen and pelvis with contrast, comparing both to post-operative histopathology specimen or intra-operative assessment in cases where no resection of the primary tumour was performed. Results CT and colonoscopy were both accurate in diagnosing 70.5% of cases that had done both investigations pre-operatively. The best results were obtained when the cancer was located in the caecum as confirmed post-operatively; the combined accuracy rate was 100%. CT was accurate, whilst colonoscopy was not in eight (6.2%) cases (all are rectal or sigmoid cancers), and colonoscopy was accurate and CT was not in 12 cases, 10 of them were rectal and two were ascending colonic. Colonoscopy was not performed in 36 (21%) cases for a variety of reasons, including large bowel obstruction or perforation on presentation. In 32 of these cases, CT scan managed to accurately predict the location of cancer (mostly rectal and caecal), and CT scan was inaccurate in 20.6% of cases (34 out of 165), whilst colonoscopy was inaccurate in 13.9% of cases (18 out of 129). Conclusion Colonoscopy is more accurate in localising colorectal cancers than CT scan of the abdomen and pelvis with contrast. CT scan diagnoses regional and distant spread of colorectal cancers such as nodal status, invasion of neighbouring organs and/or peritoneum and the presence of liver metastases, whilst colonoscopy is limited to intraluminal diagnosis but can be both a diagnostic and therapeutic tool, with higher accuracy, in general, in localising colorectal cancers. Both CT scan and colonoscopy were equal in appendicular, caecal, splenic flexure and descending colon cancer localisation accuracy.

Experimental Study on Gastric Labeling by Magnetic Detector Combined With Magnetic Bead

OBJECTIVE

Preoperative labeling of gastric cancer is an important means to determine the surgical margin. At present, there are many commonly used labeling methods. However, which is more accurate and has fewer complications remains to be studied. Through animal experiments, this study explored the feasibility, accuracy, and safety of a magnetic detector combined with magnetic beads for the preoperative labeling of gastric cancer.

METHODS

A total of 10 beagle dogs were included in the study. Each dog was randomly labeled with magnetic beads in the gastric body and antrum. After labeling, the magnetic detector was used to explore the gastric serosa surface, and the positioning titanium clip was released at the detected magnetic bead. The main monitoring index was to measure the distance between the labeled magnetic beads and the positioning titanium clamped. The secondary indexes were detection time, magnetic induction intensity, magnetic bead shedding rate, mucosal injury rate, bleeding, and leukocyte and C-reactive protein levels before and 24 hours after the operation.

RESULTS

All 10 beagle dogs completed the marking and exploration successfully. The average distance between the magnetic beads and the positioning titanium clip in 20 cases was 5.90±2.36 mm. The average detection time was 1.60±0.69 min, and the average magnetic induction intensity was 3.76±1.11 mT. No magnetic beads were found to fall off, 1 case had a mild mucosal injury, and 2 cases had a small amount of bleeding when releasing the positioning titanium clip. The white blood cells before and 24 hours after the operation were 7.43±0.94(×10 9 /L) versus 7.79±0.67(×10 9 /L) ( P =0.34). The C-reactive protein before and 24 hours after the operation were 5.24±0.97 µg/mL versus 5.95±1.02 µg/mL ( P =0.13).

CONCLUSION

A magnetic detector combined with magnetic beads for gastric cancer labeling is feasible, accurate, and safe. It is expected to be further applied in the clinic.

Fallibility of tattooing colonic neoplasia ahead of laparoscopic resection: a retrospective cohort study

INTRODUCTION

Precise geographical localisation of colonic neoplasia is a prerequisite for proper laparoscopic oncological resection. Preoperative endoscopic peri-tumoural tattoo practice is routinely recommended but seldom scrutinised.

METHODS

A retrospective review of recent consecutive patients with preoperative endoscopic lesional tattoo who underwent laparoscopic colonic resection as identified from our prospectively maintained cancer database with supplementary clinical chart and radiological, histological, endoscopic and theatre database/logbook interrogation.

RESULTS

Some 210 patients with 'tattooed' colonic neoplasia were identified, of whom 169 underwent laparoscopic surgery (mean age 68 years, median BMI 27.8kg/m2, male-to-female ratio 95:74). The majority of tumours were malignant (149; 88%), symptomatic (133; 79%) and proximal to the splenic flexure (92; 54%). Inaccurate colonoscopist localisation judgement occurred in 12% of cases, 60% of which were corrected by preoperative staging computed tomography scan. A useful lesional tattoo was absent in 11/169 cases (6.5%) being specifically stated as present in 104 operation notes (61%) and absent in 10 (5.9%). Tumours missing overt peritumoral tattoos intraoperatively were more likely to be smaller, earlier stage and injected longer preoperatively (p=0.006), although half had histological ink staining. Eight lesions missing tattoos were radiologically occult. Four (44%) of these patients had on-table colonoscopy, and five (55%) needed laparotomy (conversion rate 55% vs 23% overall, p<0.005) with one needing a second operation to resect the initially missed target lesion. Mean (range) operative duration and postoperative length of stay of those missing tattoos compared with those with tattoos was 200 (78-300) versus 188 (50-597) min and 15.5 (4-22) versus 12(4-70) days (p>0.05).

CONCLUSIONS

Tattoo in advance of attempting laparoscopic resection is vital for precision cancer surgery especially for radiologically unseen tumours to avoid adverse clinical consequence.

Autologous blood for preoperative colorectal TUMOR’S localization: A Vietnamese preliminary experience

Introduction

Laparoscopic colorectal surgery (LCRS) is the optimal choice for cases of early cancer. However, due to their early stage, one of this procedure's challenges is tumoral localization. So that, there are many methods of locating tumors preoperatively that have been studied by authors. Recently, Korean authors have reported a method of injecting autologous blood to mark the tumor before surgery with high efficiency and safety. This article aims to evaluate the effectiveness by analyzing the section biopsy's results, as well as the safety of this procedure.

Materials and method

This study is descriptive cross-section study with analysis of retrospective occurrences of case series of colonoscopy with autologous blood before surgery from October 2020 to December 2021.

Results

16 patients were recruited to the study. The average age was 62.9 ± 13.1 with male/female ratio was 8/8. 50% (8/16 patients) of all cases was early carcinomas, and by location, 62.5% of all cases was sigmoid colon tumors. All 16 patients (100%) found the tumor marking position. None of the patients had complications of marked endoscopy such as intestinal perforation, peritonitis, abdominal abscess, intestinal adhesions, etc.

Conclusion

The method of autologous blood injection to locate the tumor before laparoscopic colorectal surgery is a technique that can be performed effectively and safely.

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Laparoscopic colorectal surgery is the optimal choice for cases of early cancer.

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There are some methods of locating tumors preoperatively.

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Colonoscopy autologous blood injection can be performed effectively and safely.

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We can combine other methods to increase the certainty of tumor location.

Small-Dose Endoscopic Tattooing Using a Novel Needle for Localization Prior to Laparoscopic Surgery of Colorectal Cancer

BACKGROUNDS

Endoscopic tattooing failure by deep mural injection or tattoo leakage-induced massive staining causes localization errors or decreased laparoscopic visualization. To overcome these, we developed a novel tattoo needle with comparatively shorter needle (length, 2.5 mm) and minimal-caliber catheter (volume, 0.3 mL).

AIMS

The single-center, prospective observational study aimed to determine the efficacy and safety of a small-doze endoscopic tattooing prior to laparoscopic surgery for colorectal cancer, using the needle.

METHODS

Patients with colorectal cancer indicated for laparoscopic surgery were recruited. With the novel needle, a single tattoo was created at the anterior wall close to the lesion. During laparoscopic surgery, surgeons assessed the tattoo visibility, tattoo leakage, and the disturbance of laparoscopic view by tattoo leakage. The primary endpoint was an accurate localization by visible tattoo. Secondary endpoints were adverse events related to tattooing, the need for intraoperative endoscopy, and tattoo leakage.

RESULTS

A total of 383 tattoos in 358 patients were analyzed. Accurate tumor localization rate was 96.6% (95% confidence interval [CI]: 94.3-98.0%). No adverse events occurred. Intraoperative colonoscopy was performed in 7 (1.8%) patients with invisible tattoo. Tattoo leakage was found in 4.2% (95%CI: 2.6-6.7%), and leakage disturbed the laparoscopic view of the surgical plane in 0.7% (95%CI: 0.3-2.3%).

CONCLUSIONS

Prior to laparoscopic surgery for colorectal cancer, our endoscopic tattooing with a standardized protocol using a novel needle is considered a simple, highly reliable localization technique with an extremely safe profile, which would be valuable to reduce physician's efforts and redundant medical resources. Trial registration number UMIN000021012. Date of registration: June 2016.

Simple and Reliable Method for Gastric Subepithelial Tumor Localization Using Endoscopic Tattooing before Totally Laparoscopic Resection

Background: Totally laparoscopic surgery for early gastric cancer and subepithelial tumors has been popularized worldwide, yet localization of early or small-sized tumors is a persistent challenge due to difficulty being identified with the lack of manual tactile sensation. Thus, accurate localization with tattooing before the surgery would help improve efficiency during surgery. There are multiple methods to localize tumors before laparoscopy, each with varying advantages and disadvantages. The use of endoscopic tattooing with dye has been carried out for several decades due to its safety, lower cost, and convenience. However, there is a lack of studies on endoscopic tattooing before totally laparoscopic resection. Aims: To evaluate the effect of endoscopic tattooing with dye for gastric subepithelial tumors localization before laparoscopic resection and to evaluate the tattooing effect on different locations of tumors in stomach. Method: We retrospectively collected data of patients with gastric subepithelial tumors who underwent endoscopic tattooing before totally laparoscopic resection from 2017 to 2020 in a university affiliated medical center. All patients were analyzed for preoperative characteristics and then categorized into two groups based on tumor locations concerning the difficulty of laparoscopic surgery. The independent t test and Chi-square test were performed to compare perioperative outcome and complications between these two groups. Result: A total of 19 patients were included retrospectively at our center. The individuals were 5 male and 14 female patients with a mean age of 58.2 years old. Most patients had no symptoms, and the tumors were found incidentally in 12 patients (63%). All tumors were identified clearly during laparoscopic resection. The mean tumor size was 2.3 cm. The surgeries took an average of 111 min and a mean of 7 mL blood loss was found. All tumors had negative resection margins with no recurrence during follow-up. Gastrointestinal stromal tumor was the major pathologic diagnosis, found in 12 patients (63%), followed by the leiomyoma in 5 patients (26%). Only three patients had mild adverse effects after surgery and the symptoms were self-limited. Our analysis found no significant difference in preoperative patient characteristics and perioperative outcomes between patients with differing tumor locations. Conclusion: This study is the first and largest report on endoscopic tattooing with dye before laparoscopic resection of gastric subepithelial tumor resection. Our results emphasize that endoscopic tattooing with dye is a safe and reliable method for localizing subepithelial tumors in the stomach prior to totally laparoscopic resection, with no correlation to where the tumor is located.

Design of a Long-Pass Filter with Effects on Fluorescence Image Observation for Surgical Fluorescence Microscope Applications

The goal of oncological surgery is to completely remove the tumor. Tumors are often difficult to observe with the naked eye because of the presence of numerous blood vessels and the fact the colors of the tumor and blood vessels are similar. Therefore, a fluorescent contrast medium using a surgical microscope is used to observe the removal status of the tumor. To observe the tumor removal status using a fluorescent contrast agent, fluorescence is expressed in the tumor by irradiating with an external light source, and the expressed tumor can be confirmed through a surgical microscope. However, not only fluorescence-expressed tumors are observed under a surgical microscope, but images from an external light source are also mixed and observed. Therefore, since the surgical microscope is connected to a filter, the quality of the diagnostic image is not uniform, and it is difficult to achieve a clear observation. As a result, an asymmetric image quality phenomenon occurs in the diagnostic images. In this paper, a filter with high clarity that provides a symmetrical observation of diagnostic images is developed and manufactured.

Usefulness of Endoscopic Tattooing Before Neoadjuvant Therapy in Patients with Clinical Complete Response in Locally Advanced Rectal Cancer for Providing a Safe Distal Surgical Margin

Background: Endoscopic tattooing of colorectal tumors enables tumor localization and determination of appropriate surgical margins. It becomes very difficult to detect the distal surgical margins (DSMs) of rectal tumors in patients who obtain clinical complete response (cCR) after neoadjuvant therapy. In this study, our aim is to examine the benefits of endoscopic tattooing of the tumor before neoadjuvant therapy in patients with locally advanced rectal cancer in accurate localization of the previous tumor and in providing appropriate DSMs in cases with cCR. Patients and Methods: The patients who were diagnosed with locally advanced rectal cancer, received neoadjuvant therapy and subsequently achieved cCR, and underwent surgery between January 2015 and October 2020 were included in the study. The patients were divided into two groups according to whether they were endoscopically tattooed before neoadjuvant chemoradiotherapy. Results: A total of 49 cases were included in the study. Significantly better DSMs were observed especially in female gender in the tattooed group. DSMs were found to be closer to the resection margins in the nontattooed group. It was found that endoscopic tattooing had a significant effect on the DSM in the regression analysis (P = .06, R² = 0.47). It was determined that laparoscopy or open surgery alone did not differ in terms of DSMs but open surgery together with tattooing was found to be strongly effective in providing larger DSMs. Conclusion: In locally advanced rectal cancer, endoscopic tattooing of the distal margin of the tumor before neoadjuvant therapy is a reliable and effective method for obtaining a safe DSM and not leaving the residual tumor at the lower end of anastomosis, especially in cases of cCR.

Application of nano-carbon and titanium clip combined labeling in robot-assisted laparoscopic transverse colon cancer surgery

Background

Robot-assisted laparoscopic transverse colon tumor surgery requires precise tumor localization. The purpose of this study was to evaluate the safety and efficacy of nano-carbon and titanium clip combination labeling methods in robot-assisted transverse colon tumor surgery.

Methods

From January 2018 to January 2019, the clinical data of 16 patients who come from FuZhou, China underwent preoperative nano-carbon and titanium clip combined with robot-assisted laparoscopic transverse colon cancer surgery were retrospectively analyzed.

Results

Of the 16 patients, no signs of abdominal pain, fever, or diarrhea were observed after colonoscopy. Two titanium clips were seen on all of the 16 patients' abdominal plain films. Nano-carbon staining sites were observed during the operation, and no staining disappeared or abdominal cavity contamination. All patients underwent R₀ resection. The average number of lymph nodes harvsted was 18.23 ± 5.04 (range, 9–32). The average time to locate the lesion under the laparoscopic was 3.03 ± 1.26 min (range, 1–6 min), and the average operation time was 321.43 ± 49.23 min (range, 240–400 min). All were consistent with the surgical plan, and there was no intraoperative change of surgical procedure or conversion to open surgery.

Conclusion

Preoperative colonoscopy combined with nano-carbon and titanium clip is safe and effective in robot-assisted transverse colon cancer surgery. A At the same time, the labeling method shows potential in shortening the operation time, ensuring sufficient safety margin and reducing complications.

Preoperative Colonoscopic Tattooing Using a Direct Injection Method with Indocyanine Green for Localization of Colorectal Tumors: An Efficacy and Safety Comparison Study

Purpose

Methods

Results

Conclusion

Ways to perform an endoscopic tattoo. Prospective and randomized study in patients with colorectal neoplasm

BACKGROUND AND AIMS

intraoperative identification of colonic lesions previously detected via colonoscopy may be difficult. Endoscopic tattooing facilitates identification, but there is no evidence regarding which is the best tattoo technique. The goal of the study was to describe the efficacy and safety of endoscopic tattooing and to detect technical and clinical factors associated with its efficacy.

PATIENTS AND METHODS

a prospective and randomized study was performed. All tattoo candidate patients were included prior to surgery and randomized into four groups; tattoo at two or three injection points and with a volume of 1 or 1.5 ml of labeling. Multiple variables were registered.

RESULTS

one hundred and ninety-five patients were included with an endoscopic tattoo and who subsequently underwent a surgical intervention, the mean age was 70.1 years and 67.2 % were male. The laparoscopic approach was applied in 57.9 % of cases. The intraoperative visibility of the endoscopic tattoo was 89.7 % and 30 % of rectal lesions were not visible. Excluding the rectum, the marking was visible intraoperatively in 92 % of patients, without significant differences according to the surgical approach, the type of marking or any of the variables collected. The tattoo was safe in 92.3 % of the cases. The adverse effect rate was 7.7 % and none of the complications were clinically significant. There were no significant differences between any variables collected in relation to adverse effects.

CONCLUSIONS

endoscopic colon tattoo is safe and effective regardless of the technique used. We recommend the technique of two injection points and 1 ml of marking volume for its simplicity, efficiency and safety.

The Usefulness of Preoperative Colonoscopic Tattooing with Autologous Blood for Localization in Laparoscopic Colorectal Surgery

Purpose

In colorectal cancer surgery, it is important to have accurate resection margins. However, it is challenging to localize lesions during laparoscopy. Therefore, to reduce surgical errors, many preoperative localizing methods have been introduced. In this study, we aimed to assess the preoperative feasibility and safety of autologous blood tattooing.

Methods

A total of 11 patients underwent preoperative colonoscopic autologous blood tattooing from August 2017 to February 2020. At the start of the surgery, the surgeon assessed the patients for the precision of visibility and other complications such as abscess or spillage. The patients’ characteristics, outcomes, and complications were collected retrospectively.

Results

The study comprised 8 men and 3 women, with an average age of 63 years. Ten patients showed precise visibility, and no localization errors were observed during surgery. No complication was observed in all patients.

Conclusion

Preoperative autologous blood tattooing is a very useful and safe technique because it has high visibility with no complications. This method does not require additional agents or facilities. A large-scale study will be required to develop standard guidelines.

Endoscopic tattooing for colorectal lesions: impact on quality of care and patient outcomes

INTRODUCTION

The National Bowel Cancer Screening Programme guidelines advocate the use of endoscopic tattooing for suspected malignant lesions to assist identification and to facilitate laparoscopic resections. However, endoscopic tattooing practices are variable in endoscopic units, resulting in repeat endoscopy and delay in patient management. The aim of this study was to assess the adherence to tattoo protocol for significant colonic lesions at an endoscopy unit in a large district general hospital.

MATERIALS AND METHODS

Prospectively collected data were analysed for 252 patients with significant colonic lesions between January 2017 and December 2018. Data were collected through reviewing patient's notes, histopathology findings and endoscopy reports. Data on lesions, complications, number and site of tattoo placed, and any repeat endoscopy for a tattoo were collected.

RESULTS

Of the 252 patients, 88% (n = 222) had malignant and 12% (n = 30) had benign lesions. Only 58.7% (n = 148) of those patients who had colonoscopy had tattoo placement reported. Of these 148 cases, the report stated the distance of tattoo in relation to the lesion in only 46% (n = 68) of patients. Unfortunately, 14.3% (n = 36) of patients required repeat endoscopy to tattoo the lesions prior to surgery.

CONCLUSIONS

Our study highlights the lack of uniformity of tattoo practice among endoscopists. Despite the National Bowel Cancer Screening Programme guidelines, a significant proportion of colorectal lesions are still not tattooed during their first endoscopy. Some patients had to have repeat endoscopy just for the purpose of tattooing. Active involvement and participation of all endoscopists in the colorectal and the complex polyp multidisciplinary teams may help to improve the tattoo service.

Lesion Retrieval, Specimen Handling, and Endoscopic Marking in Colonoscopy

Retrieval of lesions after endoscopic polypectomy enables histopathologic analysis and guides future surgical management and endoscopic surveillance intervals. Various techniques and devices have been described with distinct advantages and disadvantages to accomplish retrieval. Appropriate histopathologic analysis depends on lesion handling and preparation. How lesions are handled further depends on size, endoscopic appearance, and removal technique. Endoscopic marking or tattooing is a well-described process that uses dye mediums to leave longstanding marks in the colon. Techniques, dye mediums, and locations within the colon influence tattoo approach.

New marking method involving a light-emitting diode and power source device to localize gastrointestinal cancer in laparoscopic surgery

Although the preoperative endoscopic marking method using dye is widely used, the dye can spread into the tissue or abdominal cavity, inducing the inflammation and leading to the wrong dissection. We developed a novel marking method using an endoscopic clip with a light emitting diode (LED) and a power source device to detect the accurate location of the site of interest. We performed this new marking method in three patients with gastrointestinal cancers. We placed an endoscopic clip with an LED on the gastrointestinal mucosa and used a power source device outside of the human body to detect the LED. We detected the clip with the LED using the power source device. We also confirmed the usefulness of this clip in three of three (100%) patients with colorectal and gastric cancer. We developed a novel marking device using an LED to identify an objective location successfully.

A rare case of peritoneal deposits with carbon pigmentation after preoperative endoscopic tattooing for sigmoid colon cancer

PURPOSE

We report a case in which pigmented peritoneal deposits were found during laparoscopic surgery following preoperative endoscopic tattooing for sigmoid colon cancer.

METHODS

The patient's clinical, endoscopic, and histological data from the Niigata City General Hospital were reviewed, as well as the literature on laparoscopic surgery involving the preoperative endoscopic tattoo, with a focus on the relevance of peritoneal deposits and tattooing ink.

RESULTS

A 71-year-old man presented to our hospital complaining of vomiting and abdominal distention. Abdominal computed tomography revealed obstructive sigmoid colon cancer. An emergency endoscopic colon stenting procedure and injection of 0.2 ml India ink to the submucosal layer of the tumor's anal side were performed. Laparoscopic-assisted sigmoid colectomy was done 14 days after stenting. At surgery, seven small peritoneal deposits were seen in the rectovesical pouch and at the site adjacent to the tumor. All peritoneal deposits were stained by the ink. Gross leakage of the ink into extraintestinal sites was seen. The seven peritoneal deposits were resected under laparoscope. Histological findings revealed that the seven peritoneal deposits were composed of adenocarcinoma and carbon pigments. Immunohistochemical staining for cluster of differentiation 163 showed that the carbon pigments in the peritoneal deposits were within macrophages.

CONCLUSIONS

The possibility of the tattooing procedure causing peritoneal dissemination cannot be completely denied, but it can be hypothesized that the carbon pigmentation was transferred to peritoneal deposits by macrophages. In the future, we hope that this phenomenon becomes a keystone for diagnoses and treatments for peritoneal dissemination.

Usefulness of colonic tattooing using indocyanine green in patients with colorectal tumors

AIM

To prove that tattooing using indocyanine green (ICG) is feasible in laparoscopic surgery for a colon tumor.

METHODS

From January 2012 to December 2016, all patients who underwent laparoscopic colonic surgery were retrospectively screened, and 1010 patients with colorectal neoplasms were included. Their lesions were tattooed with ICG the day before the operation. The tattooed group (TG) included 114 patients, and the non-tattooed group (NTG) was selected by propensity score matching of subjects based on age, sex, tumor staging, and operation method (n = 228). In total, 342 patients were enrolled. Between the groups, the changes in [Delta (Δ), preoperative-postoperative] the hemoglobin and albumin levels, operation time, hospital stay, oral ingestion period, transfusion, and perioperative complications were compared.

RESULTS

Preoperative TG had a shorter operation time (174.76 ± 51.6 min vs 192.63 ± 59.9 min, P < 0.01), hospital stay (9.55 ± 3.36 d vs 11.42 ± 8.23 d, P < 0.01), and post-operative oral ingestion period (1.58 ± 0.96 d vs 2.81 ± 1.90 d, P < 0.01). The Δ hemoglobin (0.78 ± 0.76 g/dL vs 2.2 ± 1.18 g/dL, P < 0.01) and Δ albumin (0.41 ± 0.44 g/dL vs 1.08 ± 0.39 g/dL, P < 0.01) levels were lower in the TG. On comparison of patients in the “N0” and “N1 or N2” groups, the N0 colon cancer group had a better operation time, length of hospital stay, oral ingestion period, Δ hemoglobin, and Δ albumin results than those of the N1 or N2 group. The operation methods affected the results, and laparoscopic anterior resection (LAR) showed similar results. However, for left and right hemicolectomy, both groups showed no difference in operation time or hospital stay.

CONCLUSION

Preoperative tattooing with ICG is useful for laparoscopic colectomy, especially in the N0 colon cancer group and LAR.

[Advancement of Common Localization of Solitary Pulmonary Nodules for Video-assisted Thracoscopic Surgery]

最近，伴随着高分辨多层电子计算机断层扫描（computed tomography, CT）的大量普及，肺小结节的诊断也日益增多，尤其是在伴有肺癌高危因素的患者行CT筛查时尤为明显。电视辅助胸腔镜手术对于肺小结节的诊断和治疗提供了一种全新的微创治疗方式，胸腔镜手术后给患者带来的疼痛感减少、住院时间缩短、手术并发症减少等特点，使其推广更为广泛。如何精准定位及标记病灶，以助电视胸腔镜下切除病灶的方法层出不穷。本文综述近年来胸腔镜下肺小结节定位的各种技术手段，并对各种方法的利弊进行总结及分析。

Preoperative Tattooing Using Indocyanine Green in Laparoscopic Colorectal Surgery

Purpose

The aim of the present study was to evaluate the usefulness of indocyanine green (ICG) as a preoperative marking dye for laparoscopic colorectal surgery.

Methods

Between March 2013 and March 2015, 174 patients underwent preoperative colonoscopic tattooing using 1.0 to 1.5 mL of ICG and saline solution before laparoscopic colorectal surgery. Patients’ medical records and operation videos were retrospectively assessed to evaluate the visibility, duration, and adverse effects of tattooing.

Results

The mean age of the patients was 65 years (range, 34–82 years), and 63.2% of the patients were male. The median interval between tattooing and operation was 1.0 day (range, 0–14 days). Tattoos placed within 2 days of surgery were visualized intraoperatively more frequently than those placed at an earlier date (95% vs. 40%, respectively, P < 0.001). For tattoos placed within 2 days before surgery, the visualization rates by tattoo site were 98.6% (134 of 136) from the ascending colon to the sigmoid colon. The visualization rates at the rectosigmoid colon and rectum were 84% (21 of 25) and 81.3% (13 of 16), respectively (P < 0.001). No complications related to preoperative ICG tattooing occurred.

Conclusion

Endoscopic ICG tattooing is more useful for the preoperative localization of colonic lesions than it is for rectal lesions and should be performed within 2 days before laparoscopic surgery.

Tattooing or not? A review of current practice and outcomes for laparoscopic colonic resection following endoscopy at a tertiary care centre

BACKGROUND

Because small colonic tumours may not be visualized or palpated during laparoscopy, location of the lesion must be identified before surgery. The aim of this study was to evaluate the effectiveness of the current recommendation of endoscopic tattooing of lesions prior to laparoscopic colonic resections.

METHODS

All consecutive patients who underwent elective laparoscopic resection for a colonic lesion at a single tertiary institution between 2013 and 2015 were identified for chart review.

RESULTS

In total, 224 patients underwent laparoscopic resection for a benign or malignant colonic lesion during the study period. All patients had a complete colonoscopy preoperatively. In all, 148 patients (66%) had their lesion tattooed at endoscopy. Most lesions were tattooed distally, but 15% were tattooed either proximally, both proximally and distally, or tattooed without specifying location as proximal or distal. Tattoo localization was accurate in 69% of cases. Tattooed lesions were not visible during surgery 21.5% of time; 2 cases were converted to open surgery to identify the lesion. Inaccuracy in endoscopic localization led to change in surgical plan in 16% of surgeries. In the nontattooed group, 1 case was converted to open surgery to localize the lesion, 3 required intraoperative colonoscopy and 1 had positive margins on final pathology.

CONCLUSION

To improve surgical planning, we recommend the practice of endoscopic tattooing of all colon lesions at a location just distal to the lesion using multiple injections to cover the circumference of the bowel wall.

Contribution of intraoperative colonoscopy in a colorectal surgery unit. Scand J Gastroenterol 2017;52:1292-1297. [PMID: 28768440 DOI: 10.1080/00365521.2017.1362465]

OBJECTIVES

Intraoperative colonoscopy (IC) is routinely used in colorectal surgery procedures, both oncologic and benign ones. Despite its extensive use there is a lack of literature addressing this important issue. The aims of this paper are to determine the contributions of this tool, especially considering changes in attitude from preoperative designed intervention.

MATERIALS AND METHODS

This study is a retrospective analysis of a prospective maintained database. Patients who underwent colorectal resection and IC during a four-year period (2009-2012). The indications for performing IC in our unit are: Incomplete preoperative colonoscopy, confirm the exact location of the tumor and polypectomy of any lesion distant from the planned resection segment.

RESULTS

The success rate in performing IC is 100%, including 42% of them made trans-anastomotic. No postoperative complications that were attributable to the endoscopy were detected. Routine practice led to a change in attitude in 5% of the patients analyzed; 2% of the global sample corresponded to synchronous tumors finding. Of those patients in whom polypectomies where achieved during the procedure a 14.3% of potentially malignant lesions were resected.

CONCLUSIONS

Intraoperative colonoscopy is a useful and safe tool that in view of these results should be taken into account at any colorectal surgery unit. Trans-anastomotic techniques do not raise morbidity.

[Endoscopic tattooing of colorectal neoplasms and laparoscopic surgery: technical aspects and recommendations]

Accurate mapping of colorectal neoplasms is needed in many clinical situations. Intraoperative mapping of small lesions previously detected by endoscopy is often challenging, especially during laparoscopic surgery. Tumor location assessed during colonoscopy may be inaccurate because of limitations of the procedure. Small flat neoplasms with signs of invasiveness, which are hard to detect by palpation, hold a special place. The same situation is observed for nonradical endoscopic resection of malignant polyps or early cancer, when visual examination shows that the tumor masses have been completely resected but histological examination reveals the positive lateral or horizontal resection margin. Endoscopic tattooing is an effective, safe, and economically sound method to mark intraluminal colorectal neoplasms, which allows one to perform minimally invasive surgeries without using additional operating room resources.

Use of a novel shorter minimum caliber needle for creating endoscopic tattoos for preoperative localization: a comparative ex vivo study

BACKGROUND AND STUDY AIMS

In colorectal cancer surgery, inadvertent deep injections during endoscopic tattooing can cause India ink leakage into the peritoneum, leading to complications or to poor visualization of the surgical plane. This ex vivo animal study compared the use of novel shorter, minimum caliber needles versus conventional injection needles for endoscopic tattooing.

ANIMALS AND METHODS

Four endoscopists used the novel needles and conventional needles to make ten endoscopic tattoos (five tattoos/needle type/endoscopist) in harvested porcine rectum using a saline test-injection method. India ink leakage and the success of the tattoo (i. e. visible, < 40 mm, plus no India ink leakage) were compared.

RESULTS

India ink leakage was observed for 30 % (6/20) of the conventional needle tattoos but for none of the novel needle tattoos ( P  = 0.02). Tattoos created using the novel needles were more successful than those made with the conventional needles: 18/20 (90 %) vs. 11/20 (55 %); P  = 0.01.

CONCLUSIONS

The use of novel shorter minimum caliber needles may be safe and effective for endoscopic tattooing for preoperative localization prior to colorectal cancer surgery.

Endoscopic tattoo: the importance and need for standardised guidelines and protocol

Preoperative endoscopic tattoo is becoming more important with the advent of minimally invasive surgery. Current practices are variable and are operator-dependent. There are no evidence-based guidelines to aid endoscopists in clinical practice. Furthermore, there are still a number of issues with endoscopic tattoo including poor intraoperative visualisation, complications from tattooing and inaccurate documentation leading to the need for intraoperative endoscopy, prolonged operative time and reoperation due to lack of oncologic resection. This review aims to collate and summarise evidence for the best practice of endoscopic tattoo for colorectal lesions in order to provide guidance for endoscopists.

Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level: 1 rate of adequate bowel preparation (minimum standard 90%); 2 cecal intubation rate (minimum standard 90%); 3 adenoma detection rate (minimum standard 25%); 4 appropriate polypectomy technique (minimum standard 80%); 5 complication rate (minimum standard not set); 6 patient experience (minimum standard not set); 7 appropriate post-polypectomy surveillance recommendations (minimum standard not set). Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.

Hematemesis With Gastric Laceration After Tattooing a Polyp With Purified Carbon: A Review of the Literature

Endoscopic tattooing is a simple and effective technique for marking small lesions, so they can be localized during surgery or in later endoscopies. Various agents can be used such as India ink or a solution of purified carbon particles. The number of complications from tattooing is relatively small, but not rare. The majority of the literature on the subject refers to complications in the colon. We present a case of gastric bleeding secondary to a laceration following tattooing with purified carbon, and a literature review.

Complication of endoscopic tattooing: a case report of covered perforation

AIM

Laparoscopy is considered a good approach in treatment of colorectal neoplastic diseases; the endoscopic tattooing is then recommended (Evidence Level III and grade of recommendation A) to mark a lesion or a polypectomy site for intraoperative identification. We describe the case of perforation after tattoing treated conservatively.

CASE REPORT

63 years old woman, underwent colonoscopy for lipoma tattooing with India ink SPOT® solution kit and saline test. Immediately after the procedure the patient has been referred the appearance of colic epi-mesogastric pain and fever; Computed Tomography (CT) without MDC identified an irregular thickening of transverse colon with some microbubbles compatible with focal peritonitis. Initial paralytic ileus was present too. The blood count and metabolic panel examinations reveal a neutrophil leucocytosis (WBC: 11.000/mmc, 80% neutrophils).

RESULTS

On the base of WSES sepsis severity score and recent literature patient was treated conservatively with total parenteral nutrition, and intravenous antibiotic therapy. After the resolution of fever and reactivation of peristalsis. The discharge occurred after six days with no early complications.

CONCLUSION

India ink tattooing with SPOT® solution kit and saline test represent the first choice. It is a feasible technique although perforation is a possible complication. It may need an immediately surgical operation but in most cases a conservative management is a good and safe tool even if surgery may be attempted too.

Using India Ink as a Sensor for Oximetry: Evidence of its Safety as a Medical Device

Clinical EPR spectroscopy is emerging as an important modality, with the potential to be used in standard clinical practice to determine the extent of hypoxia in tissues and whether hypoxic tissues respond to breathing enriched oxygen during therapy. Oximetry can provide important information useful for prognosis and to improve patient outcomes. EPR oximetry has many potential advantages over other ways to measure oxygen in tissues, including directly measuring oxygen in tissues and being particularly sensitive to low oxygen, repeatable, and non-invasive after an initial injection of the EPR-sensing material is placed in the tumor. The most immediately available oxygen sensor is India ink, where two classes of carbon (carbon black and charcoal) have been identified as having acceptable paramagnetic properties for oximetry. While India ink has a long history of safe use in tattoos, a systematic research search regarding its safety for marking tissues for medical uses and an examination of the evidence that differentiates between ink based on charcoal or carbon black has not been conducted.

METHODS

Using systematic literature search techniques, we searched the PubMed and Food and Drug Administration databases, finding ~1000 publications reporting on adverse events associated with India/carbon based inks. The detailed review of outcomes was based on studies involving >16 patients, where the ink was identifiable as carbon black or charcoal.

RESULTS

Fifty-six studies met these criteria. There were few reports of complications other than transient and usually mild discomfort and bleeding at injection, and there was no difference in charcoal vs. carbon black India ink.

CONCLUSIONS

India ink was generally well tolerated by patients and physicians reported that it was easy to use in practice and used few resources. The risk is low enough to justify its use as an oxygen sensor in clinical practice.

Endoscopic marking clip with an IC tag and receiving antenna to detect localization during laparoscopic surgery

BACKGROUND

Conventional tattooing using India ink for preoperative marking during colonoscopy has been widely used. However, the ink used in this method can spread into the abdominal cavity and induce peritonitis. Therefore, we developed a new marking method using an endoscopic clip with an integrated circuit (IC) tag to accurately identify an objective location. We applied the novel method in laparoscopic surgery using a porcine model and also evaluated it with resected human gastrointestinal tissue.

METHODS

We placed an endoscopic clip with an IC tag through a forceps aperture in the gastrointestinal tract, by using a porcine surgery model. After the endoscopic procedure, we performed laparoscopic surgery and approached the receiving antenna in the abdominal cavity to detect the IC tag through the porcine intestine. In an ex vivo examination with human colon tissues, the clip with the IC tag was placed on the mucosal surface to determine its ability to be detected. The receiving antenna near the serosal side of the human colon segment accurately detected the clip with the IC tag.

RESULTS

We detected the clip with an IC tag with a detection device, by using a laparoscopic surgery model in vivo. We also confirmed its usefulness in five of five (100 %) human colon tissue samples tested ex vivo.

CONCLUSION

We developed a novel marking device using an IC tag to identify an objective location. We successfully demonstrated the usefulness of the clip with the IC tag and the antenna device used for its detection in a porcin laparoscopic surgery model and in resected human colon tissue.

Preoperative localization of colorectal cancer: a systematic review and meta-analysis

BACKGROUND

Preoperative colorectal tumor localization is crucial for appropriate resection and treatment planning. As the localization accuracy of conventional colonoscopy is considered to be low, several localization techniques have been developed. We systematically reviewed the tumor localization error rates of several preoperative endoscopic techniques and synthesized information on risk factors for localization errors and procedure-related adverse events.

METHODS

MEDLINE, EMBASE, the Cochrane Library, and the grey literature were searched. Studies were included if they reported tumor localization errors in patients with colorectal cancer undergoing resection with curative intent. Using random-effects models, pooled incidence of tumor localization errors were derived for conventional colonoscopy and colonoscopic tattooing. Due to the lack of comparative studies, a direct comparison of the pooled estimates was performed. Procedure-related adverse events, risk factors for localization errors, and the localization outcomes of other techniques such as colonoscopic clip placement, radioguided occult colonic lesion identification, and the use of magnetic endoscope imaging were also synthesized.

RESULTS

A total of 38 non-randomized controlled and observational studies were included in this review (2578 patients underwent conventional colonoscopy and 643 colonoscopic tattooing). The pooled incidence of localization errors with conventional colonoscopy was 15.4 % (95 % CI 12.0-18.7), whereas that of colonoscopic tattooing was 9.5 % (95 % CI 5.7-13.3), mean difference 5.9 % (95 % CI 0.65-11.14, p = 0.03). Adverse events secondary to tattooing were infrequent, and most were cases of ink spillage. Limited information was available for other localization techniques.

CONCLUSION

Conventional colonoscopy has a higher incidence of localization error compared to colonoscopic tattooing for localization of colorectal cancer. Colonoscopic tattooing is safe and leads to fewer tumor localization errors. Given the widespread adoption of laparoscopic resections for colorectal cancer, routine colonoscopic tattooing should be adopted. However, studies directly comparing different localization techniques are needed.

Endoscopic tattooing to aid tumour localisation in colon cancer: the need for standardisation

BACKGROUND/AIMS

An increasing number of colon and rectal tumours are being resected using laparoscopic techniques. Identifying these tumours intraoperatively can be difficult. The use of tattooing can facilitate an easier resection; however, the lack of standardised guidelines can potentially lead to errors intraoperatively and potentially result in worse outcomes for patients. The aim of this study was to identify the most reliable method of preoperative tumour localisation from the available literature to date.

METHODS

A literature review was undertaken to identify any articles related to endoscopic tattooing and tumour localisation during colorectal surgery.

RESULTS

To date there is still mixed evidence regarding tattooing techniques and the choice of ink that should be used. There are numerous studies demonstrating safe tattooing techniques and highlighting the risks and benefits of different types of ink available.

CONCLUSION

Based on the available studies we have recommended a standardised approach to endoscopic tattooing of colorectal tumours prior to laparoscopic resection.

Intraoperative colonoscopy in patients with colorectal cancer: Review of recent developments

The use of intraoperative colonoscopy has increased alongside progress in the development of colonoscopy-associated devices and techniques, including the colonoscope itself. In the present review, we focus on four circumstances in which intraoperative colonoscopy is beneficial to colorectal surgery: (i) intraoperative determination of a tumor's location; (ii) observation of the proximal colon in cases of obstructive colorectal cancer; (iii) confirmation of the integrity of anastomosis; and (iv) novel surgical techniques that combine laparoscopic and endoscopic surgery. In light of the findings of our review, a combination of colonoscopy and surgery-especially laparoscopic surgery-is expected to facilitate the optimal handling of a variety of colorectal tumors, ranging from benign cases to advanced and obstructive cases.

Preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by using carbon nanoparticles in laparoscopy

Background

The objective of this study is to evaluate the effectiveness of preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by carbon nanoparticle tattooing in laparoscopic colorectal cancer surgery.

Methods

From January 2013 to December 2014, 54 patients with colorectal cancer were recruited and divided into experimental (n = 27) and control (n = 27) groups. The patients in the experimental group were localized preoperatively by endoscopic carbon nanoparticle tattooing, whereas patients in the control group were not tattooed.

Results

All injection sites in the experimental group were visible to surgeons. No abdominal pain, fever, diarrhea, and other symptoms of infection were found in the experimental group. The time for detecting the tumor (2.71 ± 2.13 min versus 6.91 ± 5.16 min, p < 0.001), operation time (151.22 ± 30.66 min versus 170.26 ± 33.13 min, p = 0.033), and blood loss during the operation (125.04 ± 29.48 mL versus 147.52 ± 34.35 mL, p = 0.013) were lower in the experimental group than in the control group. Average numbers of dissected lymph nodes in the experimental group exceeded those in the control group (14.41 ± 3.32 versus 8.96 ± 2.90, p < 0.001), and the rate of dissected lymph nodes ≥12 was higher in the experimental group than in the control group (70.37 versus 37.04 %, p < 0.001). Moreover, no difference in postoperative complications was found between the two groups.

Conclusions

Tattooing colorectal cancer with carbon nanoparticles in laparoscopic colorectal cancer surgery is safe and useful both in localization and lymph node tracing.

A novel endoscopic fluorescent band ligation method for tumor localization

BACKGROUND

Accurate tumor localization is essential for minimally invasive surgery. This study describes the development of a novel endoscopic fluorescent band ligation method for the rapid and accurate identification of tumor sites during surgery.

METHODS AND MATERIALS

The method utilized a fluorescent rubber band, made of indocyanine green (ICG) and a liquid rubber solution mixture, as well as a near-infrared fluorescence laparoscopic system with a dual light source using a high-powered light-emitting diode (LED) and a 785-nm laser diode. The fluorescent rubber bands were endoscopically placed on the mucosae of porcine stomachs and colons. During subsequent conventional laparoscopic stomach and colon surgery, the fluorescent bands were assayed using the near-infrared fluorescence laparoscopy system.

RESULTS

The locations of the fluorescent clips were clearly identified on the fluorescence images in real time. The system was able to distinguish the two or three bands marked on the mucosal surfaces of the stomach and colon. Resection margins around the fluorescent bands were sufficient in the resected specimens obtained during stomach and colon surgery.

CONCLUSION

These novel endoscopic fluorescent bands could be rapidly and accurately localized during stomach and colon surgery. Use of these bands may make possible the excision of exact target sites during minimally invasive gastrointestinal surgery.

Effect of preoperative colonoscopic tattooing on lymph node harvest in T1 colorectal cancer

OBJECTIVE

This study aimed to identify the impact of preoperative colonoscopic tattooing (PCT) on lymph node harvest in T1 colorectal cancer patients.

MATERIAL AND METHODS

One hundred and forty-three patients were included who underwent curative resection and were diagnosed with T1 colorectal cancer. These patients were categorized into the tattooing group and the non-tattooing group depending on whether preoperative India ink tattooing was done. Clinicopathological findings and lymph node harvest were compared between the two groups.

RESULTS

The median number of lymph nodes examined was 18 in the tattooing group and 13 in the non-tattooing group (p < 0.001). The rate of adequate lymph node harvest (retrieval of more than 12 lymph nodes) was higher in the tattooing group than that in the non-tattooing group (83.7 vs. 58.5 %, p = 0.002). The PCT was significantly associated with adequate lymph node harvest in multivariate analysis (hazard ratio, 3.8; 95 % confidence interval, 1.5-9.2; p = 0.003). Among the 40 patients who showed at least one carbon particle-containing lymph nodes, the positive lymph node rate was not different between carbon-containing LNs (0.9 %) and non-carbon-containing LNs (1.7 %).

CONCLUSIONS

PCT was associated with higher lymph node yield in T1 colorectal cancer. It is questionable if tattooing has additional detection power as a sentinel lymph node mapping tool in T1 colorectal cancer.

Practice parameters for early colon cancer management: Italian Society of Colorectal Surgery (Società Italiana di Chirurgia Colo-Rettale; SICCR) guidelines

Early colon cancer (ECC) has been defined as a carcinoma with invasion limited to the submucosa regardless of lymph node status and according to the Royal College of Pathologists as TNM stage T1 NX M0. As the potential risk of lymph node metastasis ranges from 6 to 17% and the preoperative assessment of lymph node metastasis is not reliable, the management of ECC is still controversial, varying from endoscopic to radical resection. A meeting on recent advances on the management of colorectal polyps endorsed by the Italian Society of Colorectal Surgery (SICCR) took place in April 2014, in Genoa (Italy). Based on this material the SICCR decided to issue guidelines updating the evidence and to write a position statement paper in order to define the diagnostic and therapeutic strategy for ECC treatment in context of the Italian healthcare system.

Laparoscopic colon resection: To prep or not to prep? Analysis of 1535 patients

BACKGROUND

Mechanical bowel preparation (MBP) before elective open colon resection does not reduce the rate of postoperative anastomotic leakage. However, MBP is still routinely used in many countries, and there are very limited data regarding the utility of preoperative MBP in patients undergoing laparoscopic colon resection (LCR). The aim of this study was to challenge the use of MBP before elective LCR.

METHODS

It is a retrospective analysis of a prospectively collected database. All patients undergoing elective LCR with primary anastomosis and no stoma were included. Preoperative MBP with polyethylene glycol solution was used routinely between April 1992 and December 2004, and then it was abandoned. The early postoperative outcomes in patients who had preoperative MBP (MBP group) and in patients who underwent LCR without preoperative MBP (No-MBP group) were compared.

RESULTS

From April 1992 to December 2014, 1535 patients underwent LCR: 706 MBP patients and 829 No-MBP patients. There were no differences in demographic data, indication for surgery and type of procedure performed between MBP and No-MBP group patients. The incidence of anastomotic leakage was similar between the two groups (3.4 vs. 3.6 %, p = 0.925). No differences were observed in intra-abdominal abscesses (0.6 vs. 0.8 %, p = 0.734), wound infections (0.6 vs. 1.4 %, p = 0.149), infectious extra-abdominal complications (1.8 vs. 3 %, p = 0.190), and non-infectious complications (6.1 vs. 6.8 %, p = 0.672). The overall reoperation rate was 4.6 % for MBP patients and 5 % for No-MBP patients (p = 0.813).

CONCLUSION

The use of preoperative MBP does not seem to be associated with lower incidence of intra-abdominal septic complications after LCR.