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Small-Dose Endoscopic Tattooing Using a Novel Needle for Localization Prior to Laparoscopic Surgery of Colorectal Cancer

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Abstract

Backgrounds

Endoscopic tattooing failure by deep mural injection or tattoo leakage-induced massive staining causes localization errors or decreased laparoscopic visualization. To overcome these, we developed a novel tattoo needle with comparatively shorter needle (length, 2.5 mm) and minimal-caliber catheter (volume, 0.3 mL).

Aims

The single-center, prospective observational study aimed to determine the efficacy and safety of a small-doze endoscopic tattooing prior to laparoscopic surgery for colorectal cancer, using the needle.

Methods

Patients with colorectal cancer indicated for laparoscopic surgery were recruited. With the novel needle, a single tattoo was created at the anterior wall close to the lesion. During laparoscopic surgery, surgeons assessed the tattoo visibility, tattoo leakage, and the disturbance of laparoscopic view by tattoo leakage. The primary endpoint was an accurate localization by visible tattoo. Secondary endpoints were adverse events related to tattooing, the need for intraoperative endoscopy, and tattoo leakage.

Results

A total of 383 tattoos in 358 patients were analyzed. Accurate tumor localization rate was 96.6% (95% confidence interval [CI]: 94.3–98.0%). No adverse events occurred. Intraoperative colonoscopy was performed in 7 (1.8%) patients with invisible tattoo. Tattoo leakage was found in 4.2% (95%CI: 2.6–6.7%), and leakage disturbed the laparoscopic view of the surgical plane in 0.7% (95%CI: 0.3–2.3%).

Conclusions

Prior to laparoscopic surgery for colorectal cancer, our endoscopic tattooing with a standardized protocol using a novel needle is considered a simple, highly reliable localization technique with an extremely safe profile, which would be valuable to reduce physician’s efforts and redundant medical resources.

Trial registration number UMIN000021012. Date of registration: June 2016

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Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-Gun, Shizuoka, 411-8777, Japan

    Kenichiro Imai, Kinichi Hotta, Sayo Ito, Yuichiro Yamaguchi, Yoshihiro Kishida & Hiroyuki Ono

  2. Division of Colorectal Surgery, Shizuoka Cancer Center, Nagaizumi-Cho, Suntogun, Shizuoka, Japan

    Yusuke Yamaoka, Shoichi Manabe, Hitoshi Hino, Hiroyasu Kagawa, Akio Shiomi & Yusuke Kinugasa

  3. Clinical Trial Coordination Office, Shizuoka Cancer Center, Nagaizumi-Cho, Suntogun, Shizuoka, Japan

    Keita Mori

  4. Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, Japan

    Tomohiro Yamaguchi

  5. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan

    Yusuke Kinugasa

Authors
  1. Kenichiro Imai
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  2. Kinichi Hotta
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  3. Sayo Ito
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  4. Yuichiro Yamaguchi
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  5. Yoshihiro Kishida
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  6. Yusuke Yamaoka
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  7. Shoichi Manabe
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  8. Hitoshi Hino
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  9. Hiroyasu Kagawa
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  10. Tomohiro Yamaguchi
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  11. Akio Shiomi
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  12. Yusuke Kinugasa
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  13. Keita Mori
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  14. Hiroyuki Ono
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Contributions

KI and KH contributed to study concept and design; KI, KH, SI, YY, YK, YY, SM, HH, HK, TY, AS, YK helped in acquisition of data; KI and KM were involved in analysis and interpretation of data; KI and KH were involved in drafting of the manuscript; KI, KH, SI, YY, YK, YY, SM, HH, HK, TY, AS, YK, KM, and HO contributed to critical revision of the manuscript; HO helped in final approval of the manuscript.

Corresponding author

Correspondence to Kenichiro Imai.

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Supplementary Information

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Video This video shows endoscopic tattooing and robot-assisted laparoscopic rectal resection after non-curative endoscopic resection of a lower rectal T1 cancer. Left rectal wall could be identified by water pooling because the left side of endoscopic images corresponded to the direction of gravity when the patient was in the left lateral position. A small-dose tattoo was created at the anterior wall concentric to the scar. Laparoscopic view demonstrated a localized tattoo without tattoo leakage could be identified in a good visualization of the surgical plane during robot-assisted laparoscopic surgery. Resection with adequate surgical margin could be performed by the tattoo navigation. The resected specimen revealed that rectal resection was successfully performed with appropriate surgical margins. (MOV 37237 kb)

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Imai, K., Hotta, K., Ito, S. et al. Small-Dose Endoscopic Tattooing Using a Novel Needle for Localization Prior to Laparoscopic Surgery of Colorectal Cancer. Dig Dis Sci 66, 4448–4456 (2021). https://doi.org/10.1007/s10620-020-06757-7

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  • DOI: https://doi.org/10.1007/s10620-020-06757-7

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