Faculty Collaboration Database

Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc 1997 Oct;11(10):1013-6

Date

10/08/1997

Pubmed ID

9381339

DOI

10.1007/s004649900514

Scopus ID

2-s2.0-0031252705 (requires institutional sign-in at Scopus site)   100 Citations

Abstract

BACKGROUND: Because of the inability to palpate colonic tumors during laparoscopy, their location must be precisely identified before resection is undertaken.

METHOD: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Author List

Kim SH, Milsom JW, Church JM, Ludwig KA, Garcia-Ruiz A, Okuda J, Fazio VW

Author

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Colonoscopy
Colorectal Neoplasms
Humans
Laparoscopy
Perioperative Care
Reproducibility of Results
Retrospective Studies