Safety and Efficacy of Colonoscopic Tattooing of a Colorectal Neoplasm Prior to a Laparoscopic Resection

ABSTRACT

PURPOSE: Accurate tumor localization prior to a laparoscopic surgical resection is the critical. India ink tattoos properly placed in the colorectum are long lasting and have been reported to probably remain constantly in previous studies. The present study was done to review the safety and reliability of colonoscopic tattooing prior to a laparoscopic resection of a colorectal neoplasm. METHODS: Between May 2003 and August 2004, 20 patients underwent colonoscopic tattooing of a colorectal neoplasm prior to laparoscopic surgery. The clinical data were retrospectively reviewed. RESULTS: Among the 20 patients, 14 (70%) had tumors located in the sigmoid colon, 4 (20%) had tumors in the rectosigmoid junction, and 1 had a tumor (5%) in the upper rectum and descending colon. In six patients (30%) who had received an endoscopic mucosal resection (EMR), an additional surgical resection was required to remove the tumor completely, and those 6 patients needed another preoperative colonoscopy for India ink tattooing. The median time between tattooing and resection was 2 days (range 1 to 18 days). Tattoos were visualized intraoperatively and localized the tumor accurately in 15 patients (75%). Seven patients underwent intraoperative colonoscopy; five didn't have tattoos that could be visualized intraoperatively, and two patients with visible tattoos needed intraoperative colonoscopy to confirm the site of tumor. Only one patient (5%) had mild fever with abdominal discomfort, which were relieved by hydration and administration of intravenous antibiotics for one day. CONCLUSIONS: A colorectal neoplasm can be localized with an acceptable reliability by using preoperative colonoscopic tattooing. India ink tattooing at the time of the EMR may reduce unnecessary colonoscopies if we doubt a complete resection has been achieved by using an EMR. The complications following colonoscopic tattooing were minimal.