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Thomaschewski M, Lipp M, Engelke C, Harder J, Labod I, Keck T, Mittmann K. Near-infrared fluorescence tattooing: a new approach for endoscopic marking of tumors in minimally invasive colorectal surgery using a persistent near-infrared marker. Surg Endosc 2023; 37:9690-9697. [PMID: 37872429 PMCID: PMC10709472 DOI: 10.1007/s00464-023-10491-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Intraoperative accurate localization of tumors in the lower gastrointestinal tract is essential to ensure oncologic radicality. In minimally invasive colon surgery, tactile identification of tumors is challenging due to diminished or absent haptics. In clinical practice, preoperative endoscopic application of a blue dye (ink) to the tumor site has become the standard for marking and identification of tumors in the colon. However, this method has the major limitation that accidental intraperitoneal spillage of the dye can significantly complicate the identification of anatomical structures and surgical planes. In this work, we describe a new approach of NIR fluorescent tattooing using a near-infrared (NIR) fluorescent marker instead of a blue dye (ink) for endoscopic tattooing. METHODS AFS81x is a newly developed NIR fluorescent marker. In an experimental study with four domestic pigs, the newly developed NIR fluorescent marker (AFS81x) was used for endoscopic tattooing of the colon. 7-12 endoscopic submucosal injections of AFS81x were placed per animal in the colon. On day 0, day 1, and day 10 after endoscopic tattooing with AFS81x, the visualization of the fluorescent markings in the colon was evaluated during laparoscopic surgery by two surgeons and photographically documented. RESULTS The detection rate of the NIR fluorescent tattoos at day 0, day 1, and day 10 after endoscopic tattooing was 100%. Recognizability of anatomical structures during laparoscopy was not affected in any of the markings, as the markings were not visible in the white light channel of the laparoscope, but only in the NIR channel or in the overlay of the white light and the NIR channel of the laparoscope. The brightness, the sharpness, and size of the endoscopic tattoos did not change significantly on day 1 and day 10, but remained almost identical compared to day 0. CONCLUSION The new approach of endoscopic NIR fluorescence tattooing using the newly developed NIR fluorescence marker AFS81x enables stable marking of colonic sites over a long period of at least 10 days without compromising the recognizability of anatomical structures and surgical planes in any way.
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Affiliation(s)
- Michael Thomaschewski
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Michael Lipp
- Department of Surgery, Clinic for Gastrointestinal and Colorectal Surgery, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Carsten Engelke
- Medical Clinic I, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jonas Harder
- Department of Gastroenterology, Hepatology & Interventional Endoscopy, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Isabell Labod
- EUREGIO BioMedtech Center, University of Applied Sciences Münster, Stegerwaldstr. 39, 48565, Steinfurt, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Karin Mittmann
- EUREGIO BioMedtech Center, University of Applied Sciences Münster, Stegerwaldstr. 39, 48565, Steinfurt, Germany.
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Takahashi J, Yoshida M, Ohdaira H, Nakaseko Y, Nakashima K, Kamada T, Suzuki N, Sato T, Suzuki Y. Efficacy and Safety of Gastrointestinal Tumour Site Marking with da Vinci-Compatible Near-Infrared Fluorescent Clips: A Case Series. World J Surg 2023; 47:2386-2391. [PMID: 37340097 PMCID: PMC10474167 DOI: 10.1007/s00268-023-07082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The conventional near-infrared fluorescent clip (NIRFC) ZEOCLIP FS® has been used successfully in marking tumour sites during laparoscopic surgeries. However, this clip is difficult to observe with the Firefly imaging system equipped with the da Vinci® surgical system. We have been involved in the modification of ZEOCLIP FS® and development of da Vinci-compatible NIRFC. This is the first prospective single-centre case series study verifying the usefulness and safety of the da Vinci-compatible NIRFC. METHODS Twenty-eight consecutive patients undergoing da Vinci®-assisted surgery for gastrointestinal cancer (16 gastric, 4 oesophageal, and 8 rectal cases) between May 2021 and May 2022 were enrolled. RESULTS Tumour location was identified by the da Vinci-compatible NIRFCs in 21 of 28 (75%) patients, which involved 12 gastric (75%), 4 oesophageal (100%), and 5 rectal (62%) cancer cases. No adverse events were observed. CONCLUSION Tumour site marking with da Vinci-compatible NIRFC was feasible in 28 patients enrolled in this study. Further studies are warranted to substantiate the safety and improve the recognition rate.
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Affiliation(s)
- Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan.
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan
| | - Yuichi Nakaseko
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan
| | - Keigo Nakashima
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan
| | - Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan
| | - Norihiko Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi University, Kohasu Oko-Cho 185-1, Nankoku, Kochi, 783-8505, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan
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Kuo E, Wang K, Liu X. A Focused Review on Advances in Risk Stratification of Malignant Polyps. Gastroenterology Res 2020; 13:163-183. [PMID: 33224364 PMCID: PMC7665855 DOI: 10.14740/gr1329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer is the third most common cancer in both men and women in the United States, with most cases arising from precursor adenomatous polyps. Colorectal malignant polyps are defined as cancerous polyps that consist of tumor cells invading through the muscularis mucosae into the underlying submucosa (pT1 tumor). It has been reported that approximately 0.5-8.3% of colorectal polyps are malignant polyps, and the potential for lymph node metastasis in these polyps ranges from 8.5% to 16.1%. Due to their clinical significance, recognition of malignant polyps is critical for clinical teams to make treatment decisions and establish appropriate surveillance schedules after local excision of the polyps. There is a rapidly developing interest in malignant polyps within the literature as a result of an increasing number of identifiable adverse histologic features and recent advancements in endoscopic treatment techniques. The purpose of this paper is to have a focused review of the recent histopathologic literature of malignant polyps.
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Affiliation(s)
- Enoch Kuo
- Department of Pathology, Immunology & Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA.,Both authors contributed equally to this manuscript
| | - Kai Wang
- Department of Pathology, Immunology & Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA.,Both authors contributed equally to this manuscript
| | - Xiuli Liu
- Department of Pathology, Immunology & Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Barberio M, Pizzicannella M, Spota A, Ashoka AH, Agnus V, Al Taher M, Jansen-Winkeln B, Gockel I, Marescaux J, Swanström L, Kong SH, Felli E, Klymchenko A, Diana M. Preoperative endoscopic marking of the gastrointestinal tract using fluorescence imaging: submucosal indocyanine green tattooing versus a novel fluorescent over-the-scope clip in a survival experimental study. Surg Endosc 2020; 35:5115-5123. [PMID: 32989536 PMCID: PMC8346416 DOI: 10.1007/s00464-020-07999-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intraoperative localization of endoluminal lesions is can be difficult during laparoscopy. Preoperative endoscopic marking is therefore necessary. Current methods include submucosal tattooing using visible dyes, which in case of transmural injection can impair surgical dissection. Tattooing using indocyanine green (ICG) coupled to intraoperative near-infrared (NIR) laparoscopy has been described. ICG is only visible under NIR-light, therefore, it doesn't impair the surgical workflow under white light even if there is spillage. However, ICG tattoos have rapid diffusion and short longevity. We propose fluorescent over-the-scope clips (FOSC), using a novel biocompatible fluorescent paint, as durable lesion marking. METHODS In six pigs, gastric and colonic endoscopic tattoos using 0.05 mg/mL of ICG and markings using the fluorescent OSC were performed (T0). Simultaneously, NIR laparoscopy was executed. Follow-up laparoscopies were conducted at postoperative day (POD) 4-6 (T1) and POD 11-12 (T2). During laparoscopy, fluorescence intensity was assessed. In one human cadaver, FOSC was used to mark a site on the stomach and on the sigmoid colon, respectively. Intraoperative detection during NIR laparoscopy was assessed. RESULTS Gastric and colonic ICG tattooing and OSC markings were easily visible using NIR laparoscopy on T0. All FOSC were visible at T1 and T2 in both stomach and colon, whereas the ICG tattooing at T1 was only visible in the stomach of 2 animals and in the colon of 3 animals. At T2, tattoos were not visible in any animal. FOSC were still visible in both stomach and colon of the human cadaver at 10 days. CONCLUSION Endoscopic marking using FOSC can be an efficient and durable alternative to standard methods.
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Affiliation(s)
- Manuel Barberio
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France.
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.
| | - Margherita Pizzicannella
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Andrea Spota
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Anila Hoskere Ashoka
- Laboratoire de Bio-Imagerie et Pathologies, UMR 7021 CNRS, Université de Strasbourg, Strasbourg, France
| | - Vincent Agnus
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Mahdi Al Taher
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Lee Swanström
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Seong-Ho Kong
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
- Department of Surgery, Seoul National University, Seoul, South Korea
| | - Eric Felli
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Andrey Klymchenko
- Laboratoire de Bio-Imagerie et Pathologies, UMR 7021 CNRS, Université de Strasbourg, Strasbourg, France
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
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Barberio M, Pizzicannella M, Laracca GG, Al-Taher M, Spota A, Marescaux J, Felli E, Diana M. Endoscopic Preoperative Tattooing and Marking in the Gastrointestinal Tract: A Systematic Review of Alternative Methods. J Laparoendosc Adv Surg Tech A 2020; 30:953-961. [PMID: 32584653 DOI: 10.1089/lap.2020.0373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: An accurate and reliable localization of endoluminal gastrointestinal (GI) lesions is crucial, particularly during minimally invasive surgery. As an extreme consequence, a misdetected GI lesion can lead to the resection of the wrong segment, especially in colorectal surgery. A preoperative endoscopic marking is recommended in case of GI lesions, which are expected to be difficult to detect from the serosal side. In clinical practice, three preoperative endoscopic marking methods are currently used: India ink, SPOT™, and endoclips with intraoperative fluoroscopy. All of them have substantial limitations. This has encouraged research on alternative solutions. Methods: In the current systematic review, animal and clinical studies about alternative preoperative endoscopic marking methods of GI lesions were analyzed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Thirty studies were found using PubMed/MEDLINE, EMBASE/Ovid, and the Cochrane Library for the qualitative analysis. Conclusion: Although several smart solutions have been proposed and tested successfully, all of them seem to have a substantial drawback related either to scarce stability on the marking site or potential spreading on the bowel wall or diffusion into the surgical planes.
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Affiliation(s)
- Manuel Barberio
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | | | | | - Mahdi Al-Taher
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Andrea Spota
- IRCAD, Research Institute against Digestive Cancer, Strasbourg, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute against Digestive Cancer, Strasbourg, France
| | - Eric Felli
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute against Digestive Cancer, Strasbourg, France
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Imai K, Hotta K, Ito S, Yamaguchi Y, Kawakami T, Wada T, Igarashi K, Kishida Y, Kinugasa Y, Kawata N, Tanaka M, Kakushima N, Takizawa K, Ishiwatari H, Matsubayashi H, Ono H. Use of a novel shorter minimum caliber needle for creating endoscopic tattoos for preoperative localization: a comparative ex vivo study. Endosc Int Open 2017; 5:E513-E517. [PMID: 28596984 PMCID: PMC5462608 DOI: 10.1055/s-0043-106182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 03/02/2017] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan,Corresponding author Kenichiro Imai Division of EndoscopyShizuoka Cancer Center1007 ShimonagakuboNagaizumi, Suntogun, Shizuoka, 411-8777Japan+81-55-989-5692
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Takuya Wada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan,Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan
| | | | | | - Yusuke Kinugasa
- Division of Colorectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masaki Tanaka
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Gonzalez-Tallon AI, Rivero-Fernandez M, Calvo-Ramos I, Diaz-Sanchez A, Del Rosario Gonzalez-Alonso M, la Fuente-Briongos ED, Manzano-Fernandez R, Moya-Valverde E, Riesco-Lopez JM, Campos-Cantero R. Hematemesis With Gastric Laceration After Tattooing a Polyp With Purified Carbon: A Review of the Literature. Gastroenterology Res 2017; 10:45-49. [PMID: 28270877 PMCID: PMC5330693 DOI: 10.14740/gr728w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
| | - Miguel Rivero-Fernandez
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Irina Calvo-Ramos
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Antonio Diaz-Sanchez
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | | | | | - Rebeba Manzano-Fernandez
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Eloisa Moya-Valverde
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Jose Maria Riesco-Lopez
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Rocio Campos-Cantero
- Department of Gastroenterology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
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Kim JH, Kim WH. [Colonoscopic Tattooing of Colonic Lesions]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 66:190-3. [PMID: 26493503 DOI: 10.4166/kjg.2015.66.4.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
With the development of minimal invasive surgery including laparoscopic and robot surgery, colonoscopic tattooing of colonic lesions is becoming more important to ensure easy localization of the lesion during surgery. Lack of accurate lesion identification during minimal invasive surgery may lead to resection of wrong segment of the bowel. In this article, some topics including proper materials, injection technique, and safety of colonoscopic tattooing are reviewed.
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Affiliation(s)
- Jae Hyun Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Ghersin I, Sroka G, Haj B, Ghersin DS, Matter I. Inadvertent tattooing of adjacent large bowel: a case report and review of literature. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:161-2. [PMID: 25004299 PMCID: PMC4678671 DOI: 10.1590/s0102-67202014000200017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 11/23/2013] [Indexed: 11/22/2022]
Affiliation(s)
- Itai Ghersin
- Israel Institute of Technology, Rappaport Faculty of Medicine
| | - Gideon Sroka
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel
| | - Bassel Haj
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel
| | | | - Ibrahim Matter
- Department of Surgery, Bnai Zion Medical Center, Haifa, Israel
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Garg V, Alvarado N, Raju R. CT-guided percutaneous administration of Spot sterile carbon stain to a single F-18 FDG positive mesenteric lymph node to allow identification during subsequent laparoscopic resection. ABDOMINAL IMAGING 2014; 39:1134-6. [PMID: 24699936 DOI: 10.1007/s00261-014-0132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the feasibility and efficacy of CT-guided percutaneous administration and off-label use of Spot sterile carbon stain (GI Supply, Camp Hill, PA) to a single PET-positive mesenteric lymph node to allow identification during subsequent laparoscopic resection. METHODS An asymptomatic 61-year-old male veteran with past medical history only for benign prostatic hyperplasia presented with a mildly elevated PSA. A screening CT demonstrated a 2.3 × 0.8 cm mesenteric mass and findings resembling mesenteric panniculitis; however, following PET revealed F-18 FDG avidity, and a neoplastic process could not be entirely excluded. An initial attempt at percutaneous biopsy was non-diagnostic. Therefore, a second percutaneous intervention with localization and off-label administration of Spot dye was performed to aid in subsequent laparoscopic resection. RESULTS The Spot dye was identified during laparoscopy and the PET-positive mesenteric mass was successfully resected. Histology diagnosed the non-malignant etiology of organizing hematoma. A follow-up PET/CT confirmed interval resection of the previous PET-avid mass. CONCLUSIONS This case report is the first to describe the off-label administration and use of Spot dye by a CT-guided percutaneous technique, allowing improved visualization during subsequent laparoscopic resection. Spot is composed of sterile, carbon-based particles which leave a permanent tattoo and is FDA-approved for the inking of the Gastrointestinal tract. Interventional radiologists should consider the off-label use of Spot dye in marking regions of interest as it safely provides a permanent tattoo which may aid in future identification.
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Affiliation(s)
- Vasant Garg
- Department of Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA,
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Abstract
The value of performing comprehensive screening colonoscopy with complete colon polypectomy is widely accepted. Colon cancer is a significant cause of worldwide mortality and prospective studies have proven that colonoscopic polypectomy reduces both the incidence and mortality related to this disease. Over the past few decades the array of instruments and techniques have greatly expanded to assist with the safe endoscopic removal of colon polyps. This article will review the published literature regarding efficacy and safety of standard polypectomy techniques such as snare polypectomy, electrocautery, and endoscopic mucosal resection along with newer techniques such as endoscopic submucosal dissection and combined laparoscopic techniques.
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Chen N, Lamba R, Lee J, Lall C. Mesenteric air embolism following enteroscopic small bowel tattooing procedure. J Clin Imaging Sci 2012; 2:86. [PMID: 23393642 PMCID: PMC3551506 DOI: 10.4103/2156-7514.105270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 11/30/2012] [Indexed: 11/15/2022] Open
Abstract
Double balloon enteroscopy (DBE) is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT) findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.
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Affiliation(s)
- Natalie Chen
- Department of Radiology, University of California, Irvine, 333 City Blvd. West Suite #1405, Orange Ca 92868, USA
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Trakarnsanga A, Akaraviputh T. Endoscopic tattooing of colorectal lesions: Is it a risk-free procedure? World J Gastrointest Endosc 2011; 3:256-60. [PMID: 22195235 PMCID: PMC3244942 DOI: 10.4253/wjge.v3.i12.256] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 11/11/2011] [Accepted: 12/01/2011] [Indexed: 02/05/2023] Open
Abstract
Endoscopic tattooing is one of the most useful tools for the localization of small colorectal lesions especially in the laparoscopic setting. This is a minimally invasive endoscopic procedure without risk of major complications. However, many studies have revealed complications resulting from this procedure. In this article, several topics are reviewed including the accuracy, substance preparation, injected techniques and complications related to this procedure.
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Affiliation(s)
- Atthaphorn Trakarnsanga
- Atthaphorn Trakarnsanga, Thawatchai Akaraviputh, Minimally Invasive Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Kethu SR, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, Kwon RS, Mamula P, Pedrosa MC, Rodriguez SA, Wong Kee Song LM, Tierney WM. Endoscopic tattooing. Gastrointest Endosc 2010; 72:681-5. [PMID: 20883844 DOI: 10.1016/j.gie.2010.06.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 06/10/2010] [Indexed: 02/08/2023]
Abstract
The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through January 2010 for articles related to endoscopic tattooing by using the Keywords tattooing, colonic, endoscopic, India ink, indocyanine green in different search term combinations. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
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Nagata K, Endo S, Tatsukawa K, Kudo SE. Intraoperative fluoroscopy vs. intraoperative laparoscopic ultrasonography for early colorectal cancer localization in laparoscopic surgery. Surg Endosc 2007; 22:379-85. [PMID: 17522916 DOI: 10.1007/s00464-007-9415-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 03/05/2007] [Accepted: 03/14/2007] [Indexed: 12/25/2022]
Abstract
BACKGROUND In colorectal cancer (CRC) surgery, precise tumor localization is important for oncologically correct surgery and adequate tumor and lymph node resection margins. During laparoscopic surgery it is difficult to localize early CRC. The aim of this study was to compare the usefulness of two tumor localization techniques; intraoperative fluoroscopy and intraoperative laparoscopic ultrasonography. METHODS Seventeen patients with CRC necessitating preoperative marking were alternately allocated to either the fluoroscopy (F) group (n = 8) or the laparoscopic ultrasonography (LU) group (n = 9). A three-step technique was used. At first lesions were localized preoperatively by metallic clips that were colonoscopically applied proximally and distally to the tumor site. Second, computed tomography (CT) colonography was taken to obtain preoperative staging. The location of the metallic clips was confirmed by CT colonography, preoperatively. Third, in the F group, intraoperative fluoroscopy was performed to localize the applied clips. In the LU group, the applied clips were detected from the serosal aspect of the colon using intraoperative laparoscopic ultrasonography. RESULTS In all patients, colonoscopic metallic clips were successfully applied and preoperative CT colonography correctly detected the location of the tumor. Marking sites were detected precisely using intraoperative fluoroscopy or intraoperative laparoscopic ultrasonography in all cases, without complications. The mean detection time was 15.8 minutes in the F group and 7.0 minutes in the LU group (p = 0.005). In the LU group, two cases were technically difficult because of interruption of the ultrasound by intestinal air. CONCLUSIONS Both intraoperative fluoroscopy and intraoperative laparoscopic ultrasonography are safe and accurate techniques for intraoperative localization of early CRC. With regard to detection time, intraoperative laparoscopic ultrasonography is superior to intraoperative fluoroscopy. However, when there is a massive amount of intestinal air, intraoperative laparoscopic ultrasonography is cumbersome in localizing the lesion. Computed tomography colonography is useful for preoperative tumor localization and might be effective for shortening detection time during surgery.
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Affiliation(s)
- Koichi Nagata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan.
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Feingold DL, Addona T, Forde KA, Arnell TD, Carter JJ, Huang EH, Whelan RL. Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. J Gastrointest Surg 2004; 8:543-6. [PMID: 15239988 DOI: 10.1016/j.gassur.2003.12.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Accurate tumor localization is critical to performing minimally invasive colorectal resection. This study reviews the safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. We retrospectively reviewed 50 consecutive patients with colorectal neoplasms who underwent endoscopic tattooing prior to laparoscopic resection. Data were obtained from medical charts, endoscopy records, and pathology reports. No complications related to endoscopy or tattooing were incurred. Five neoplasms (10%) were in the ascending colon, five (10%) were in the transverse colon, eight (16%) were in the descending colon, 23 (46%) were in the sigmoid colon, and nine (18%) were in the rectum. Tattoos were visualized intraoperatively and accurately localized the neoplasm in 44 patients (88%). Six patients (12%) did not have tattoos visualized laparoscopically and required intraoperative localization. On average, the pathology specimens in this series had a 15 cm proximal margin, a 12 cm distal margin, and 15 lymph nodes. In the context of laparoscopic colorectal resection, preoperative endoscopic tattooing is a safe and reliable method of tumor localization in most cases. Localizing colon and proximal rectal lesions with tattoos may be preferable to other localization techniques including intraoperative endoscopy.
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Affiliation(s)
- Daniel L Feingold
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
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Catanzaro A, Wong RCK. Endoscopic tattooing facilitates repeated localization and endoscopic therapy of a difficult-to-find minor papilla in pancreas divisum. Gastrointest Endosc 2003; 58:803-5. [PMID: 14595330 DOI: 10.1016/s0016-5107(03)02023-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Andrew Catanzaro
- University Hospital of Cleveland, Division of Gastroenterology, Cleveland, Ohio, USA
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Feitoza AB, Gostout CJ, Burgart LJ, Burkert A, Herman LJ, Rajan E. Hydroxypropyl methylcellulose: A better submucosal fluid cushion for endoscopic mucosal resection. Gastrointest Endosc 2003; 57:41-7. [PMID: 12518129 DOI: 10.1067/mge.2003.25] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Formation of a submucosal fluid cushion has become integral to endoscopic mucosal and polyp resection. Solutions available for injection into the submucosa of the GI tract create short-lasting submucosal fluid cushions or are costly. The feasibility, durability, and histologic response to submucosal fluid cushions created by injection of hydroxypropyl methylcellulose were studied in the esophagus of pigs. METHODS Thirty-six esophageal submucosal fluid cushions created with hydroxypropyl methylcellulose were studied in 12 animals divided in 2 groups of 6 animals each. In Group I, 18 submucosal fluid cushions were created by submucosal injection of hydroxypropyl methylcellulose followed by tattooing. In Group II, 18 submucosal fluid cushions were created by submucosal injection of hydroxypropyl methylcellulose, with sites marked by an endoscopically placed suture. In all cases, the duration of the submucosal fluid cushion was measured. After 7 days, submucosal fluid cushion sites were assessed by EGD, necropsy, and histologic evaluation. RESULTS The mean submucosal fluid cushion duration was 36 minutes (3-45 minutes) and 38 minutes (5-45 minutes) for, respectively, Groups I and II. EGD and necropsy after 1 week showed normal-appearing mucosa at the site of all submucosal fluid cushions in both groups. Some Group I animals additionally had nodules at the tattoo sites. Histologic assessment demonstrated minimal alterations in 33 of 36 (92%) submucosal fluid cushion sites and localized mild inflammatory reaction in 3 of 36 (8%). In Group I, 8 of 18 (44%) tattoo sites exhibited a significant inflammatory reaction, including 3 abscesses. CONCLUSIONS Hydroxypropyl methylcellulose creates a long-lasting submucosal fluid cushion with minimal tissue reaction and should be considered a low-cost option for creating submucosal fluid cushions. The use of tattooing with carbon black should be carefully considered when histologic study is required to assess potential inflammatory tissue responses to an invasive technique or instillation of foreign material in the GI tract.
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Affiliation(s)
- Arnaldo B Feitoza
- Developmental Endoscopy Unit, Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
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Bahadursingh AM, Driver M, Koenig CL, Longo WE. Inadvertent transmural India ink tattooing simulating intestinal infarction. Am J Surg 2003; 185:88-9. [PMID: 12531454 DOI: 10.1016/s0002-9610(02)01113-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Anil M Bahadursingh
- Department of Surgery, Division of Colon and Rectal Surgery, Saint Louis University Health Sciences Center, St. Louis VA Medical Center, St. Louis, MO 63110-0250, USA.
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Askin MP, Waye JD, Fiedler L, Harpaz N. Tattoo of colonic neoplasms in 113 patients with a new sterile carbon compound. Gastrointest Endosc 2002; 56:339-42. [PMID: 12196769 DOI: 10.1016/s0016-5107(02)70035-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic marking of intestinal lesions is essential when difficulty is anticipated with subsequent localization during surgical resection or postpolypectomy surveillance. The most commonly used indelible marker has been India ink, which must be diluted and sterilized, a cumbersome process. SPOT, a prepackaged, sterile Food and Drug Administration-approved formulation of pure carbon particles in suspension, eliminates the need for preinjection preparation. METHODS Ten patients with colonic polyps deemed endoscopically unresectable or malignant-appearing had the area surrounding the lesions injected with SPOT and subsequently underwent surgical resection. An additional 103 patients underwent colonoscopic injection with SPOT and were followed endoscopically or underwent surgery at another hospital. RESULTS The SPOT injection sites were visible to the surgeons in all 10 cases. On histopathologic evaluation, none of the resection specimens exhibited necrosis or abscess formation. In total, there were 118 SPOT injections in 113 patients; none had fever, abdominal pain, or any other signs or symptoms of inflammation develop. In the nonoperated group, 42 patients subsequently underwent colonoscopies at our institution, and in all cases stains were readily identifiable at the injection sites. CONCLUSIONS SPOT is a safe and effective marker for use at colonoscopy when surgical resection is anticipated. It is also useful for endoscopic follow-up of patients who have not undergone surgery.
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Affiliation(s)
- Matthew P Askin
- Division of Gastroenterology, Mount Sinai Medical Center, New York, New York, USA
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Ginsberg GG, Barkun AN, Bosco JJ, Burdick JS, Isenberg GA, Nakao NL, Petersen BT, Silverman WB, Slivka A, Kelsey PB. Endoscopic tattooing: February 2002. Gastrointest Endosc 2002; 55:811-4. [PMID: 12024133 DOI: 10.1016/s0016-5107(02)70409-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Meng MV, Koppie TM, Duh QY, Stoller ML. Novel method of assessing surgical margin status in laparoscopic specimens. Urology 2001; 58:677-81. [PMID: 11711335 DOI: 10.1016/s0090-4295(01)01417-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To develop a novel method of inking laparoscopic specimens before piecemeal extraction to evaluate the surgical margins. METHODS Methylene blue, indigo carmine, and India ink were tested in vitro on cadaveric bovine kidneys before manual morcellation in laparoscopic retrieval bags, and subsequently in pigs in vivo undergoing laparoscopic nephrectomy. Tissue fragments were examined both grossly and microscopically after routine histologic processing. On the basis of the findings in these experiments, we used India ink clinically in 4 cases of laparoscopic nephrectomy and adrenalectomy for suspected tumor and assessed the ability to indicate specimen margins grossly and microscopically. RESULTS Methylene blue and India ink were the substances that best covered the surface of the surgical specimen completely, were best retained on the tissue, and were most easily washed from the retrieval bag. Gross inspection of the morcellated specimens easily distinguished the inked pieces, signifying tissue present at the surgical margin, from the uninked pieces. During morcellation, neither contamination of central tissue with ink nor leakage of ink from the bag occurred. India ink consistently endured fixation, embedding, and sectioning, with the black, inked margins of the specimen visible microscopically. CONCLUSIONS Application of India ink before laparoscopic organ morcellation specifically marks the margins of the specimen. This technique allows pathologic determination of the surgical margin status, as well as fractionation of the tissue fragments, and addresses a criticism of organ morcellation. These improvements in the pathologic analysis of laparoscopically excised specimens may obviate the need for intact organ removal.
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Affiliation(s)
- M V Meng
- Department ofUrology, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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Ball M. A product review for sterile India ink from PERMARK. Gastroenterol Nurs 2000; 23:135-6. [PMID: 11235445 DOI: 10.1097/00001610-200005000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shatz BA, Weinstock LB, Thyssen EP. Inflammatory bowel disease after India ink tattooing: too much of a good thing. Gastrointest Endosc 2000; 51:253. [PMID: 10650286 DOI: 10.1016/s0016-5107(00)70171-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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