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1.
Background Because palpating colonic tumors during laparoscopy is impossible, the precise location of a tumor must be identified before
operation. The aim of this study was to evaluate the accuracy of various diagnostic methods that are used to localize colorectal
tumors and to propose an adequate localization protocol for laparoscopic colorectal surgery.
Methods A total of 310 patients underwent laparoscopy-assisted colectomy between April 2000 and March 2006. We investigated if the
locations of the tumors that were estimated preoperatively were consistent with the actual locations according to the operation.
Results All the tumors were correctly localized and resected. Altogether, 203 patients had complete endoscopic reports available.
Colonoscopy was inaccurate for tumor localization in 23 cases (11.3%). In total, 104 patients (33.5%) underwent barium enema;
five tumors (4.8%) were not visualized, and three tumors were incorrectly localized. Another group of 94 patients (30.3%)
underwent computed tomography (CT) colonography, which identified 91 of 94 lesions (96.8%). Finally, 96 patients (31.0%) underwent
endoscopic tattooing; 2 patients (2.1%) did not have tattoos visualized laparoscopically and required intraoperative colonoscopy
to localize their lesions during resection. Dye spillage was found in six patients intraoperatively, but only one patient
experienced clinical symptoms. Intraoperative colonoscopy was performed in four patients; two of the four were followed by
endoscopic tattooing, and the other two underwent intraoperative colonoscopy for localization. All lesions were correctly
localized by intraoperative colonoscopy. The accuracy of tumor localization was as follows: colonoscopy (180/203, 88.7%),
barium enema (97/104, 93.3%), CT colonography (89/94, 94.7%), endoscopic tattooing (94/96, 97.9%), and intraoperative colonoscopy
(4/4, 100%).
Conclusions With a combination of methods, localization of tumors for laparoscopic surgery did not seem very different from that during
open surgery. Preoperative endoscopic tattooing is a safe, highly effective method for localization. In the case of tattoo
failure, intraoperative colonoscopy can be used for accurate localization. 相似文献
2.
Daniel?L.?Feingold Tommaso?Addona Kenneth?A.?Forde Tracey?D.?Arnell Joseph?J.?Carter Emina?H.?Huang Richard?L.?Whelan
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. Weretrospectively 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 cmproximal margin, a
12 cmdistal 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. 相似文献
3.
目的评价术前亚甲蓝定位、金属夹定位和术中纤维结肠镜定位在腹腔镜结直肠肿瘤手术中的应用效果。方法复旦大学附属肿瘤医院2009年12月至2012年6月间收治的64例结直肠肿瘤患者在行腹腔镜手术前进行了肿瘤定位,其中术前2h内4点法亚甲蓝定位23例,术前1d金属夹定位20例,术中纤维结肠镜定位21例,定位后行腹腔镜结直肠肿瘤根治性手术、肠段切除或局部切除术。结果所有手术均获成功,无手术死亡和并发症发生。术前亚甲蓝定位标记成功率为82.6%(19/23),2例因亚甲蓝弥散导致组织界限不清行中转开腹手术,2例肿瘤因腹腔面肠壁无亚甲蓝显色而无法定位,遂于术中加行纤维结肠镜定位。术前金属夹定位标记成功率为85.0%(17/20),2例乙状结肠肿瘤和1例直肠上段肿瘤因无法确定下切缘而于术中加行纤维结肠镜定位。术中肠镜定位标记成功率为95.2%(20/21),1例因病灶为长蒂腺瘤未能准确定位。对于术前亚甲蓝和金属夹定位失败而加行术中结肠镜定位的5例患者中,2例准确定位并成功施行腹腔镜手术;1例因病灶为长蒂腺瘤未准确定位;2例定位准确但因小肠和结肠胀气明显,手术空间不足致中转开腹手术。结论上述3种定位方法用于腹腔镜结直肠肿瘤手术均可获得较为满意的定位效果。临床实践中应根据肿瘤位置和拟行的手术方式来选择适宜的肿瘤定位方法。 相似文献
4.
S. H. Kim J. W. Milsom J. M. Church K. A. Ludwig A. Garcia-Ruiz J. Okuda V. W. Fazio 《Surgical endoscopy》1997,11(10):1013-1016
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.
Received: 18 July 1996/Accepted: 10 March 1997 相似文献
5.
Objective Laparoscopic surgery for colorectal cancer is now widespread. Small lesions in the colon can be difficult to palpate and with lack of tactile sensation, it is essential to accurately localize them preoperatively. This is a review article on current methods of tattooing including the use of different agents and associated complications.
Aim To review current techniques in preoperative tumour localization and methods used for colonic tattooing including agents used, dosage and potential complications.
Method A literature search (Medline and Pubmed) was performed with manual cross referencing of all articles related to colonic tattooing.
Results Methods for localizing colonic tumours for laparoscopic resection include preoperative barium enema examination, CT colonography and intraoperative colonoscopy. The most effective method is, however, by tattooing with India ink performed endoscopically before surgery.
Conclusion India ink is a reliable method of marking tumour location within the colon as prelude to laparoscopic resection. Surgeons must, however, be aware of potential complications associated with this technique. 相似文献
Aim To review current techniques in preoperative tumour localization and methods used for colonic tattooing including agents used, dosage and potential complications.
Method A literature search (Medline and Pubmed) was performed with manual cross referencing of all articles related to colonic tattooing.
Results Methods for localizing colonic tumours for laparoscopic resection include preoperative barium enema examination, CT colonography and intraoperative colonoscopy. The most effective method is, however, by tattooing with India ink performed endoscopically before surgery.
Conclusion India ink is a reliable method of marking tumour location within the colon as prelude to laparoscopic resection. Surgeons must, however, be aware of potential complications associated with this technique. 相似文献
6.
Medhat E. Allam Dhiren Mehta Johnathan Zelen Richard Fogler 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》1998,2(1):83-84
Objective:
To demonstrate the application of tattooing for the intraoperative localization of posterior wall gastric leiomyoma during laparoscopic resection. The preoperative injection of Indian ink in the tumor-bearing area of the posterior gastric wall eliminates the need to perform anterior wall gastrostomy or intraoperative upper endoscopic tumor localization.Methods:
A patient with posterior wall gastric leiomyoma was marked with Indian ink during preoperative upper endoscopy. The dye was visualized intraoperatively facilitating wedge resection of the tumor-bearing area with the Endo GIA.Results:
The patient had an uneventful surgery and recovery. Complete excision of the tumor was accomplished.Conclusion:
The preoperative endoscopic marking of gastric lesions, facilitates the intraoperative localization and resection of these lesions. 相似文献7.
Surgical usefulness of indocyanine green as an alternative to India ink for endoscopic marking 总被引:1,自引:1,他引:0
Miyoshi N Ohue M Noura S Yano M Sasaki Y Kishi K Yamada T Miyashiro I Ohigashi H Iishi H Ishikawa O Imaoka S 《Surgical endoscopy》2009,23(2):347-351
Background India ink has been commonly used for preoperative colonic tattooing, but various complications have been reported. This study
aimed to evaluate the usefulness of indocyanine green (ICG) marking as a replacement for India ink.
Methods This study enrolled 40 patients who between January 2005 and February 2006 underwent laparoscopic or open surgery for colorectal
lesions considered difficult to locate intraoperatively. Because one patient had a history of allergy to iodinated contrast
material, metal clipping was used instead of ICG to mark the lesion. Endoscopists injected 5 ml of ICG suspension and saline
solution adjacent to the lesion at duplicate locations to evaluate the visibility, duration, and adverse effects of the dye.
For 39 patients, the date of the preoperative colonoscopy was not set for examination of the appropriate interval between
endoscopic marking and the surgical operation.
Results The median interval between ICG marking and surgery was 4 days (range, 1–73 days). All 29 patients who underwent surgery within
8 days after marking had positive green ICG staining at the time of surgery. After 9 days or more, however, positive staining
was seen clearly in only two of the remaining 10 patients. The staining tended to grow weaker and fainter over the time course,
eventually dissipating. No perioperative adverse reactions to the dye were observed.
Conclusion This study supports the use of ICG as a safe technique that can be identified reliably during operations performed within
8 days after endoscopic injection. 相似文献
8.
Hanno Spatz Andreas Probst Daniel Oruzio Matthias Anthuber Helmut Messmann Hans M. Arnholdt Bruno Märkl 《Surgical endoscopy》2010,24(3):589-593
Background
Correct tumor localization is crucial for proper surgical therapy in colorectal cancer. Intraoperative visualization of the lesion is facilitated by preoperative colonoscopic tattooing, regardless of whether an open or laparoscopic approach is employed. 相似文献9.
Safety of preoperation endoscopic tattoo with india ink for identification of colonic lesions 总被引:1,自引:0,他引:1
Background: Colonic tattooing with india ink is a widely practiced technique regarded as safe, accurate, and reliable. In this series,
the largest reported, the safety of this technique is studied.
Methods: A retrospective study of 8,125 consecutive patients who undersent colonoscopy over a 64-month period was conducted. India
ink colonic mucosal tattooing was used for either preoperative marking or future endoscopic identification of a lesion.
Results: During the study, 195 patients underwent endoscopic injection of india ink. Of these, 50 patients were marked before surgery,
and 145 underwent marking with the intent of facilitating future endoscopic localization. Patients were followed by either
telephone interviews or physical examination. None of the patients developed fever, persistent abdominal pain, or abdominal
tenderness on examination. All surgeons were interviewed. They uniformly reported the tattoo as intensely visible and of great
utility in locating the lesions.
Conclusions: Preoperative mucosal tattooing with india ink is recommended as a safe and necessary procedure.
Received: 31 March 1998/Accepted: 1 August 1998 相似文献
10.
Arteaga-González I Martín-Malagón A Fernández EM Arranz-Durán J Parra-Blanco A Nicolas-Perez D Quintero-Carrión E Luis HD Carrillo-Pallares A 《World journal of surgery》2006,30(4):605-611
Background Endoscopic India ink marking techniques are often used for the intraoperative location of colonic polyps and early stage neoplasms.
The aim of this study was to compare how effective this technique is compared with conventional localization methods, as well
as its influence on the results of colorectal laparoscopy (LSCRC) for endoscopically advanced tumors.
Methods From January 2003 to January 2005, 47 patients with colorectal carcinomas were included in the study. In one group, lesions
were localized preoperatively by endoscopic India ink tattooing (n = 21; tattooed group, TG), while conventional methods were used in the others (n = 26; non-tattooed group, NTG). Patients’ perioperative clinical and pathoanatomical data were prospectively collected.
Results Both groups were comparable in age, sex distribution, American Society of Anesthesiologists (ASA) score, body mass index (BMI),
technique performed, tumor size and proportion of patients who had previous abdominal surgery. Three patients presented ink
spillage without clinical repercussions. Visualization of the correct resection site was higher in the TG (100% vs. 80.8%,
P = 0.03). Operative time (147.3 ± 46.2 vs. 187.0 ± 52.7 minutes, P = 0.02) and blood loss (99.3 ± 82.8 vs. 163.6 ± 96.6 cc, P = 0.03) were lower in the TG. There were no differences between groups regarding peristalsis, introduction of oral intake,
hospital stay or intra- and postoperative complication rates. No differences were observed amongst pathoanatomical data studied.
Conclusions Preoperative endoscopic tattooing is a safe and effective technique for intraoperative localization of advanced colorectal
neoplasms, improving the operative results of LSCRC. 相似文献
11.
A novel lymphatic mapping technique to improve localization and staging of early colon cancer during laparoscopic colectomy 总被引:9,自引:0,他引:9
Encouraging results from our previous studies of sentinel lymph node (SLN) mapping in colorectal cancer (CRC) prompted investigation of its feasibility and accuracy during laparoscopic colectomy for early CRC. Between 1996 and 2000, 14 patients with clinically localized colorectal neoplasms underwent colonoscopic tattooing of the primary site and SLN mapping. In each case 0.5 to 1 cm3 of isosulfan blue dye was injected submucosally via the colonoscope. The blue-stained lymphatics were visualized through the laparoscope and followed to the SLN, which was marked with a clip, and laparoscopic colectomy was completed in the routine fashion. All lymph nodes were examined by hematoxylin and eosin (H&E) staining; in addition each SLN was subjected to focused examination by multisectioning and immunohistochemical staining using cytokeratin antibody. In all 14 patients the primary neoplasm and an SLN were identified laparoscopically. An average of 13.5 total lymph nodes and 1.7 SLNs per patient were identified. The SLN correctly reflected the tumor status of the nodal basin in 93 per cent of the cases. In four cases with unexpected lymphatic drainage, the extent of mesenteric resection was altered. In two cases (14%), nodal involvement was micrometastatic, confined to an SLN, and identified only by immunohistochemical staining. Lymphatic mapping caused no complications and added only 10 to 15 minutes to the overall operative time. Comparison of results in this group with results for a matched group of 14 patients undergoing SLN mapping during open colon resection showed that the laparoscopic technique had similar rates of accuracy and success. These preliminary findings indicate that colonoscopic/laparoscopic SLN mapping during laparoscopic colon resection is a feasible and technically simple means of identifying the primary colorectal neoplasm and its SLN. Focused pathologic examination of this node can upstage CRC and thereby may improve selection of patients for adjuvant chemotherapy. 相似文献
12.
Tattooing provides accurate localization for tumor surgery following radiation therapy. This paper describes studies done on tattooing technique and instruments available currently. Procedures tested included hypodermic needles and three types of surgical instruments. Chemical tested included india ink, iron oxide, and colored pigments. India ink and iron oxide used with the Spaulding-Rogers Outliner gave satisfactory tattoos. 相似文献
13.
目的探讨术前点墨标记在腹腔镜早期胃癌根治术中的应用价值。方法 2014年1月至2016年12月对于需要腹腔镜手术的25例早期胃癌患者,采用术前点墨标记的方法,对其临床资料进行总结。结果 25例患者点墨标记后,术中在胃壁浆膜侧可清晰显示直径约1 cm的黑色墨染斑,对病变部位、拟切除范围感知满意,判定良好,无需其他辅助方法均顺利完成早期胃癌的根治性切除,无中转开放手术。术中剖开胃腔观察病变和术后病理证实,所有切除标本均获得充足的安全切缘。切缘阴性率100%,25例患者平均获取淋巴结(19.7±5.2)枚。结论术前点墨标记在腹腔镜早期胃癌根治术中具有重要的应用价值。 相似文献
14.
Wood TF Spirt M Rangel D Shen P Tsioulias GJ Morton DL Bilchik AJ 《Surgical endoscopy》2001,15(7):715-719
Background: Recently, lymphatic mapping (LM) of the sentinel lymph node (SN) has been coupled with ultrastaging methods to
diagnose nodal micrometastases from colorectal cancer (CRC). We have developed a technique for LM at the time of laparoscopic
colon resection (LCR). Methods: Between August 1996 and February 2000, 11 patients with small early-stage CRC underwent laparoscopic
LM and LCR. The primary tumor/polyp site was visualized through a colonoscope and either tattooed preoperatively with a carbon
dye (India ink), or stained intraoperatively by peritumoral injection of isosulfan blue dye. Immediately after intraoperative
injection of blue dye, efferent lymphatic channels were visualized through the laparoscope and followed to the SN. Each blue-stained
SN was marked with a suture or clip. Results: In all 11 cases, laparoscopic LM identified between one and three SN draining
the primary tumor. LM added ~15-20 min to the operating time. The SN correctly reflected the nodal status of the entire specimen
in all cases. In the one node-positive case, micrometastases were found only in an SN and only after cytokeratin immunohistochemistry
(CK-IHC). In four cases, LM demonstrated unexpected primary lymphatic drainage that prompted an increase in the margins of
resection. Conclusions: LM during laparoscopic colectomy for CRC may be useful to mark the primary tumor site and to demonstrate
lymphatic drainage that can alter the margins of resection. Focused examination of SN identifies occult micrometastases that
up-stage CRC.
apd: 2 May 2001 相似文献
15.
Keisuke Uehara Yuichiro Yoshioka Tomoki Ebata Yukihiro Yokoyama Masanao Nakamura Naoki Ohmiya Hidemi Goto Masato Nagino 《Surgery today》2013,43(9):1062-1065
The clinical introduction of double-balloon endoscopy (DBE) has brought about a revolution in the diagnosis and the treatment of diseases of the small intestine. DBE allows not only direct observation of the entire small intestine, but also interventional therapies, tissue sampling and India ink marking (tattooing). Single incision laparoscopic surgery (SILS) was developed from conventional laparoscopic surgery to further reduce the degree of invasiveness. SILS requires only one umbilical incision, thus resulting in almost scarless surgery. This report presents three cases of small intestinal bleeding successfully treated by SILS following tattooing under DBE. The average operative time was 67 min and average blood loss was 5 ml. All patients immediately recovered without any complications. SILS, in conjunction with presurgical tattooing by DBE for small intestinal bleeding is considered to be an ideal approach in terms of minimal surgical trauma and aesthetics. 相似文献
16.
Koji Ando Eiji Oki Tetsuo Ikeda Hiroshi Saeki Satoshi Ida Yasue Kimura Yuuji Soejima Masaru Morita Ken Shirabe Tetuya Kusumoto Yoshihiko Maehara 《Surgery today》2014,44(8):1588-1592
It is now common to resect colorectal cancer by laparoscopic surgery. Hepatectomy has become a standard treatment for patients with colorectal cancer with resectable liver metastases. The resection of liver tumors can now be done partly by laparoscopic surgery. However, metastatic tumors in the right lobe are often difficult to resect laparoscopically. Furthermore, simultaneous resection of the colorectum and liver may also be difficult. In this study, we evaluated a new method to resect both colorectal cancer and liver metastases in the right lobe by laparoscopic surgery. Two cases are presented that underwent total laparoscopic resection of a right lobe tumor, associated with laparoscopic colorectal resection. The metastatic tumor in the right lobe was first resected in the left hemi-prone position. Then, the colorectal cancer was resected in the lithotomy position. The method for resecting the right lobe liver tumor and colorectal cancer was safe and feasible. The mean duration of surgery was 443.5 min, and the mean blood loss was 158 mL. The postoperative course was uneventful. In selected patients, laparoscopic hepatectomy for right lobe synchronous metastatic tumors can be safely performed simultaneously with colorectal surgery. 相似文献
17.
Background
Knowledge of the intraoperative location of lesions is a prerequisite for deciding the proper extent of gastric resection or the choice of anastomosis technique during totally laparoscopic distal gastrectomy (TLDG) for early gastric cancer (EGC). In this study we introduce a novel tumor localization method for TLDG: endoscopic blood tattooing.Methods
Twenty-three consecutive patients scheduled for TLDG for EGC were enrolled in this prospective study. The day before surgery, 2–3?ml of autologous blood was injected into the gastric muscle layer at 3–4?cm proximal to the lesion during endoscopy.Results
The study subjects consisted of 15 males and 8 females with a mean age of 61?±?10.4?years. During surgery, the endoscopic blood tattooed sites were successfully identified in all 23 patients. No complications associated with the procedure occurred, and no patient had microscopic residual tumor cells at the proximal resection margin, with a mean proximal margin length of 3.3?±?2.7?cm. Eighteen patients underwent TLDG with Billroth II anastomosis, four patients with Roux-en-Y gastrojejunostomy, and one patient with laparoscopic total gastrectomy. At final pathologic examinations, 20 patients were of stage IA and 3 were of stage IB according to the UICC TNM classification (6th ed.).Conclusions
Endoscopic blood tattooing provides a simple and useful means of localizing lesions during TLDG for EGC. Although the superiority of this technique over other localization methods needs to be evaluated further, the authors recommend endoscopic blood tattooing as an alternative to other intraoperative localization methods for laparoscopic surgery for EGC. 相似文献18.
Applicability of laparoscopic surgery for colorectal disease 总被引:2,自引:0,他引:2
Knook MM Targarona EM Garriga J Cerdan G Trias M 《Journal of laparoendoscopic & advanced surgical techniques. Part A》2000,10(5):263-268
BACKGROUND: The advantages of laparoscopic colorectal surgery for selected patients have been well established. However, the applicability of laparoscopic surgery in the whole population of patients with colorectal disease is not well known. METHODS: A single-institution medical records review of 269 patients subjected to colorectal surgery was made. Of these, 206 open colorectal procedures were performed, and data were reviewed retrospectively. In addition, 63 patients were subjected to laparoscopy, and their data were recorded prospectively. An analysis of the existence of factors that contraindicate laparoscopic colorectal surgery was done. These factors were of two types: absolute (urgent intervention, severe cardiopulmonary disease, advanced liver cirrhosis, tumor invasion into adjacent organs, simultaneous major surgery) and relative (midrectal tumors, tumors in the transverse colon, bulky tumors, more than two previous infraumbilical operations, previous intestinal surgery, and previous peritonitis). RESULTS: Factors that could contraindicate the laparoscopic approach were found in 118 patients (44%). The most common were urgent intervention (40%), midrectal tumors (19%), locally advanced cancer (13%), previous intestinal surgery (13%), and tumors >10 cm (6%). We considered 25% of the contraindications to be absolute and 19% relative. Taking these exclusion criteria into consideration when selecting patients for laparoscopic surgery, the conversion rate in our initial laparoscopic series (63 cases) was 13%. CONCLUSION: The indication for laparoscopic surgery for patients with colorectal disease is superior to 60% (absolute 56%, relative 81%). When using appropriate selection criteria, the conversion rate may be maintained below 10%. Preoperative selection of patients with colorectal disease allows optimal use of the advantages of laparoscopic surgery. 相似文献
19.
20.