Novel Technique for Preoperative Localization of Colorectal Tumors for Laparoscopic Resection

Clip or Tattooing: A Comparative Study for Preoperative Colon Cancer Endoscopic Localization

Background and Aim

Preoperative endoscopic markers have been extensively used for the localization of colonic neoplastic lesions in laparoscopic surgery. We conducted this respective cohort study to compare the localization accuracy of two commonly used endoscopic marker strategies (endoscopic clip plus abdominal plain film and endoscopic tattooing).

Methods

Patients who received preoperative colonoscopy localization for colonic neoplasia and underwent an elective laparoscopic operation afterward between 2013 and 2020 were included in this retrospective study. The localization accuracy of the two endoscopic strategies was compared, and the predictors of successful endoscopic localization were identified by multivariate regression.

Results

In total, 195 patients [average age 62.4 ± 9.2 years, 123 male (63.1%)] undergoing preoperative colonoscopy localization and subsequent laparoscopic colectomy for colonic neoplasms were included. Endoscopic localization was finally proven to be successful in 150 (76.9%) patients in the surgery. Compared to the tattooing group, patients who had successful localization for colonic lesions were fewer in the clip group (64 of 101 cases, 63.4% vs. 86 of 94 cases, 91.5%, p < 0.001). The multivariate regression analysis showed that the endoscopic tattooing strategy, endoscopic clip strategy, and lesion location were all predictors for successful localization (all with p < 0.001).

Conclusion

Compared with endoscopic clip plus abdominal plain film, endoscopic tattooing had higher localization accuracy and less intraoperative colonoscopy counseling; the endoscopic clip strategy, tattooing strategy, and colonic lesion location were all predictors of successful endoscopic localization.

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.

New inductive proximity sensor platform for precise localization of small colorectal tumors

Location of small gastric or colorectal tumors during a laparoscopic procedure is often imprecise and can be misleading. There is a real need for a compatible and straightforward tool that can be used intraoperatively to help the surgeon in this regard. We emphasize in the present work on the fabrication of a new and innovative inductive proximity switch architecture, fully compatible with laparoscopic surgery and with direct application in precise localisation of bowel tumors. An electromagnetic detection probe optimized for laparoscopic surgery and preconditioned for sterilisation was designed and constructed. Various metallic markers designed to be attached to the gastrointestinal mucosa were used for detection by the probe, from standard endoscopic and laparoscopic haemostatic clips to other custom made tags. Experiments were performed in dry and wet-lab experimental laboratory environment using ex-vivo segments of calf's small bowel and colonic surgical specimens from human patients. The dry-lab detection range varied considerably depending on the metallic component of the tags, from 0.5 mm for the endoscopic hemostatic clip to 3.5 mm for the 0.9 mm thickness stainless-steel custom tags. The latter was actually detectable from the serosal side of the fresh colonic surgical specimens in 85% of the attempts if the scanned area was less than 150 cm² and less than 2 mm of fat was interposed between the probe and the bowel. The newly designed system has the potential to discover metallic tags attached to the bowel mucosa for precise intraoperative laparoscopic location of digestive tumors. Further work is in progress to increase the sensitivity and detection range of the system in order to make it fully compatible with the clinical use.

"Is CT Scan more Accurate than Endoscopy in Identifying Distance from the Anal Verge for Left Sided Colon Cancer? A Comparative Cohort Analysis"

Purposes: Accurately localizing colorectal cancer during surgery may be challenging due to intraoperative limitations. In the present study, localization of left-sided colon cancer (LCC) by CT scan is compared to colonoscopy. Material and methods: Consecutive patients with LCC located by colonoscopy and CT scan and undergoing left-hemicolectomy were included. Tumor distance from the anal verge (TDAV) was calculated by both CT-scan and colonoscopy, and then compared, using as reference TDAV measured intraoperatively. Statistical analysis was performed including (1) comparison of means between all three TDAVs, (2) comparison of mean differences between all three TDAVs, (3) comparison of number of patients with a difference between endoscopic TDAV and intraoperative TDAV ≤5 cm and the number of patients with a difference between CT scan TDAV and intraoperative TDAV ≤5 cm (4) statistical relationship between either CT scan and endoscopic and intraoperative TDAVs. Results: Both CT scan and endoscopy overestimate TDAV (25.8 ± 12.5 cm and 24.6 ± 10.6 cm vs. 21.5 ± 7.4 cm, p = 0.005), but CT scan TDAV resulted as being different from intraoperative TDAV (p < 0.01). Regression analysis reported an increasing divergence of measurements with increasing values of intraoperative TDAV, which resulted greater for CT. Tumors within 5 cm of intraoperative TDAV were 22/28 (78.6%) for endoscopy, and 17/28 (60.7%) for CT (p = 0.2448). Conclusions: Accuracy of both examinations seems poor, with a mean overestimation >3 cm and a significant number of tumors found at >5 cm from preoperative evaluation. Preoperative examinations' bias increase proportionally with TDAV length, decreasing their interest especially for tumors located at a greater distance from anal verge.

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.