Preoperative Colonic Lesion Localization with Charcoal Nanoparticle Tattooing for Laparoscopic Colorectal Surgery
ABSTRACT The efficiency and safety of charcoal nanoparticle tattooing in localizing unpalpable colonic small lesions for later laparoscopy is described. Twenty six patients were enrolled for this prospective study. Tumor sites were localized with charcoal nanoparticles during colonoscopy for later laparoscopic colorectal operations. In all patients, the entire colon was examined preoperatively by colonoscopy and 0.5 ml (5 mg) of charcoal nanoparticle was injected submucosally near lesions or polypectomy sites. During laparoscopic colorectal operations for these biopsy-proven tumors, tumors were easily identified. The mean resection margin was 3.13 +/- 2.01 cm. The mean length of resected intestinal segment was 12.69 +/- 4.39 cm. No tumor was found at the resection line as indicated by postoperative pathological examination. Most importantly, no wrong segment was resected. Thus we show that easy identification of tumor can be achieved by preoperative tattooing with charcoal nanoparticles. Further studies regarding the long-term tattooing of tumor with charcoal nanoparticles are warranted.
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ABSTRACT: Laparoscopic colon resection is technically challenging, and conversion to open surgery is sometimes unavoidable. The impact of conversion may vary among different types of colorectal resection and pathology. Our present study aims at evaluating the risk factors and clinical outcomes of conversion in laparoscopic resection for right colon cancer. Between the periods April 1992 to July 2007, 183 consecutive patients undergoing laparoscopic-assisted right colon resection for carcinoma of colon were identified from our database. Data pertaining demographic information, operative details, postoperative course, complications, length of stay, 30-day mortality, and follow-up status were analyzed. The overall conversion rate was 12% (22 patients). Stage IV disease, tumor length >5 cm, and surgery performed in an earlier time period (before year 2002) were independent risk factors for conversion. Although the median operative time was comparable (195 vs 180 min, p = 0.074), more blood loss was recorded among the conversion group (350 vs 20 ml, p < 0.001). Conversion was also associated with higher wound infection rate (27.3% vs 5%, p = 0.002) and 30-day mortality (9.1% vs 0.62%, p = 0.039). After potential curative resection, the 5-year overall survival rate of the conversion and no conversion group was 53.8% and 72.6%, respectively (p = 0.039). Our results showed that conversion increased the intraoperative blood loss, wound related morbidities, and the 30-day mortality. Moreover, it had negative impact on overall survival.International Journal of Colorectal Disease 08/2010; 25(8):983-8. DOI:10.1007/s00384-010-0972-z · 2.42 Impact Factor
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ABSTRACT: Because of the inability to palpate colonic tumors during laparoscopy, their location must be precisely identified before resection is undertaken. A retrospective study was performed of 58 patients in order to be able to describe our methods of tumor localization for laparoscopic colorectal operations and to review their effectiveness. In all patients, the entire colon was examined preoperatively by colonoscopy. In one patient, preoperative colonoscopic localization was inaccurate. In 31 patients, tumors were easily detectable at surgery. In five patients with the tumor in the right colon, even though the lesion was not detectable at surgery, right colectomy was performed without marking because preoperative colonoscopy reliably identified the lesion adjacent to the ileocecal valve. Twenty-two patients required some type of procedure to localize the tumor. The procedures and their problems were as follows: preoperative tattoo (five)--tattoo not visualized (one); intraoperative colonoscopy alone (six), combined with intraoperative tattoo (four) or clip (three)--poor operative exposure due to bowel distension (nine), hard to see the clip (three), dislodged clip (two), inadequate resection margin (one); intraoperative proctoscopy alone (two), combined with laparoscopic stitch (two)--no problems. In no patient was tumor present at a resection line and in no patient was the wrong segment resected. Reliable preoperative identification of the tumor adjacent to the ileocecal valve can permit right colectomy without marking. Lesions in the upper rectum can be approached via intraoperative proctoscopy +/- suture placement. If the surgeon anticipates intraoperative localization may be difficult, lesions other than rectal or cecal ones should probably be marked by preoperative tattooing. Further studies regarding the technique of tattooing are warranted.Surgical Endoscopy 11/1997; 11(10):1013-6. DOI:10.1007/s004649900514 · 3.31 Impact Factor
- Gastrointestinal Endoscopy 06/1999; 49(5):636-9. DOI:10.1016/S0016-5107(99)70395-0 · 4.90 Impact Factor