Autologous blood, a novel agent for preoperative colonic localization: a safety and efficacy comparison study

Safety and efficacy of autologous blood tattooing for preoperative colonic localization: a comparative study with conventional India ink tattooing

BACKGROUND

India ink has been a popular choice for a tattooing agent in preoperative endoscopic localization but often results in unfavorable effects. Subsequently, autologous blood tattooing has arisen as an alternative option. Due to the limited availability of comparative studies on the matter, we conducted a study to compare the perioperative outcomes associated with India ink tattooing versus autologous blood tattooing.

METHODS

A total of 96 patients who underwent minimally invasive surgical procedures for left-sided colonic neoplasm following preoperative endoscopic localization were included in the study. These patients were categorized into two groups: 36 patients who received India ink tattooing and 60 patients who underwent autologous blood tattooing. The perioperative outcomes including procedure-related outcomes and postoperative outcomes were compared between the two groups.

RESULTS

There was no significant difference in visibility and spillage of tattooing agent between India ink group and autologous blood group. However, India ink group showed a higher incidence of post-tattooing fever, higher level of postoperative C-reactive protein level, longer time to first flatus, resumption of surgical soft diet, and duration of hospital stay, and a higher occurrence of postoperative complications including ileus and surgical site infection compared with the autologous blood group. In the multivariate analysis, India ink tattooing was significantly associated with the occurrence of postoperative complications. In the subgroup analysis involving patients with intraperitoneal spillage, the autologous blood group demonstrated significantly favorable perioperative outcomes compared with India ink group.

CONCLUSIONS

Autologous blood tattooing demonstrated comparable visibility and enhanced safety, establishing it as a potential alternative to India ink for preoperative endoscopic localization.

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.

Assessment of Autologous Blood marker localIzation and intraoperative coLonoscopy localIzation in laparoscopic colorecTal cancer surgery (ABILITY): a randomized controlled trial

BACKGROUND

Laparoscopic colorectal surgery has been proved to have similar oncological outcomes with open surgery. Due to the lack of tactile perception, surgeons may have misjudgments in laparoscopic colorectal surgery. Therefore, the accurate localization of a tumor before surgery is important, especially in the early stages of cancer. Autologous blood was thought a feasible and safe tattooing agent for preoperative endoscopic localization but its benefits remain controversial. We therefore proposed this randomized trial to the accuracy and safety of autogenous blood localization in small, serosa-negative lesion which will be resected by laparoscopic colectomy.

METHODS

The current study is a single-center, open-label, non-inferiority, randomized controlled trial. Eligible participants would be aged 18-80 years and diagnosed with large lateral spreading tumors that could not be treated endoscopically, malignant polyps treated endoscopically that required additional colorectal resection, and serosa-negative malignant colorectal tumors (≤ cT3). A total of 220 patients would be randomly assigned (1:1) to autologous blood group or intraoperative colonoscopy group. The primary outcome is the localization accuracy. The secondary endpoint is adverse events related to endoscopic tattooing.

DISCUSSION

This trial will investigate whether autologous blood marker achieves similar localization accuracy and safety in laparoscopic colorectal surgery compared to intraoperative colonoscopy. If our research hypothesis is statistically proved, the rational introduction of autologous blood tattooing in preoperative colonoscopy can help improve identification of the location of tumors for laparoscopic colorectal cancer surgery, performing an optimal resection, and minimizing unnecessary resections of normal tissues, thereby improving the patient's quality of life. Our research data will also provide high quality clinical evidence and data support for the conduction of multicenter phase III clinical trials.

TRIAL REGISTRATION

This study is registered with ClinicalTrials.gov, NCT05597384. Registered 28 October 2022.

Preoperative tumor marking with indocyanine green prior of robotic colorectal resections

This prospective case-series study aimed to assess the usefulness of preoperative colonoscopic marking of colorectal tumors using Indocyanine Green (ICG) fluorescence in patients that underwent robotic surgical colorectal resections. Consecutive patients that were eligible for colorectal resection with intent to cure in a single hospital (Athens Medical Center), from February 2022 to June 2022, were included. ICG solution was injected into the submucosal layer at 2 opposite sites (180 degrees apart) distal to the tumor, without submucosal elevation. Identification of the tumor marking was then performed after switching to near-infrared (NIR) fluorescence mode. During the robotic procedure, qualitative evaluation of fluorescence was performed by the surgical team (primary surgeon, first assistant, second assistant, research fellow). All 10 patients underwent robotic surgical approach and operations included right-sided colectomy (n = 1), left-sided colectomy (n = 6) and low anterior resection (n = 3). Visualisation of this dye with near-infrared light was very clear with bright intensity in all patients when the marking was performed one day prior of surgery. Preoperative tumor marking with ICG was identified intraoperatively in all cases and the techinque was easily reproducible.

CT guided autologous blood localization of pulmonary ground glass nodules for video assisted thoracoscopic surgery compared to micro-coil localization

OBJECTIVES

To investigate feasibility and safety of autologous blood in preoperative computed tomography (CT)-guided localization of pulmonary ground-glass nodules (GGNs) by comparing to mico-coil prior to video-assisted thoracoscopic surgery.

METHODS

Clinical data of patients with GGNs who underwent video-assisted thoracoscopic surgery followed by preoperative CT-guided autologous blood or micro-coil localization was retrospectively reviewed in our department between September 2019 and November 2021. The localization duration, localization success rate, localization-related complication, localization cost, operation time, and conversion rate were compared between the 2 localization groups.

RESULTS

Totally 65 patients with 65 GGNs were included in our study, with 34 patients in autologous blood group (group B) and 31 patients in micro-coil group (group M). There is no conversion to thoracotomy. The age, sex, nodule location, diameter of nodule and distance from the pleura between the 2 groups were statistically comparable. Compared with group M, group B had similar localization success rate (94.1% vs 83.9%, P = 0.183) but shorter localization time (14.50 ± 2.61 min vs 16.35 ± 2.30 min, P = 0.004), lower cost ($92.4 ± 3.2 vs $475.6 ± 8.5, P = 0.001), and lower incidence of puncture complications (3.0% vs 19.3%, P = 0.042).

CONCLUSIONS

The autologous blood localization is an effective and more economical method for preoperative GGNs localization, and is associated with fewer complications compared to micro-coil localization.

A Metal Detector for Clip Location Tracking of Stomach and Colon Cancer during Laparoscopic Surgery

In laparoscopic surgery for colorectal and gastric cancer, it is difficult to locate the tumor in the cavity for excision. Tumors in the colon or stomach are blocked by mucous membranes; thus, the view from the cavity is obscured. Therefore, to determine the location of the tumor, a marker can be installed around the tumor and the location of the tumor can be found using a sensor. Until now, most of the clip-detectors that have been developed can detect the location of tumors for either colorectal or gastric cancer. The research on the development of a detector that can detect the location of tumors for both colorectal and gastric cancer, is insufficient. Most detectors for tumor location determination are devised using a magnet by connecting a wire to a clip. In this method, the position of the magnet moves along the length of the wire. Therefore, it is difficult for the detector to detect the exact location of the tumor. Based on this method, this study designs a clip maker to determine the location of a tumor and a detector that can detect the clip. The clip and the sensing element are directly connected. The clip is developed using ferrite and coil to generate a magnetic field induced by an eddy current in the metal (clip), and the detector is designed using the Colpitts oscillator to induce a magnetic field. After installing the prepared clip at the tumor location, the detector is used to detect the clip, and accordingly, the location of the tumor can be identified using the detector. To test the performance of the clip and detector, we conducted animal experiments. In the course of the animal experiment, four clips were installed in the colon and stomach, and we succeeded in detecting all the clips. Because the clip-detector is used to locate the tumor during laparoscopic surgery, an endoscope must be used. Therefore, it is predicted that the demand for laparoscopic surgery and endoscopic medical industry will increase because of the clip-detector.

Clip-Detector Using a Neodymium Magnet to Locate Malignant Tumors during Laparoscopic Surgery

During laparoscopic surgery for colorectal or gastric cancers, locating the tumor for excision is difficult owing to it being obscured by mucous membranes. Therefore, a clip can be installed around the tumor, which can be located using a sensor. Most of the clip-detectors developed thus far can only detect tumors in either the colon or stomach and require a wire to connect the clip and detector. This study designs a clip and detector that can locate a tumor in the stomach and colon. The clip contains a neodymium magnet that generates a magnetic field, and the detector includes a Colpitts oscillator that allows magnetic coupling of the clip and detector. After installing the prepared clip at the tumor location, the detector is used to locate the clip. To test the clip and detector, we conducted animal experiments, during which four clips were installed in the colon and stomach of a mini pig. We succeeded in locating the clips within 2.17 and 3.14 s in the stomach and colon, respectively, which were shorter than the detection times reported in previous studies. The demand for laparoscopic surgery and endoscopes is predicted to increase owing to this method.

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.

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

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.

Preoperative Colonoscopic Tattooing with Autologous Blood in Laparoscopic Colorectal Cancer Surgery: Red-Flagging for an Invisible Enemy

In patients with early colorectal cancer, intraoperative localization of the target lesion is troublesome. Several strategies have also been studied for the preoperative localization of colorectal tumors. These include CT colonography, endoscopic metal clipping, endoscopic tattooing, and intraoperative colonoscopy. On the other hand, preoperative tattooing can lead to technical failure for effective tattooing or result in intraperitoneal complications. To minimize these adverse events, several studies performed tattooing with the patient's blood.