Preoperative localization of colonic tumors using transabdominal illumination of the colonoscope

Abstract

Dear Editor: Colonoscopy is recommended for colorectal polyps in both diagnostic and therapeutic purposes. It was estimated that more than 85% of polyps could be removed by means of colonoscopic polypectomy, although this mainly depends on the size, type, and location of the lesion as well as on the experience and judgment of the performing endoscopist. Those unsuitable for colonoscopic polypectomy are referred to surgeons for surgical resection, which has options of either the laparoscopic or open approach. Laparoscopic resection requires instruments and surgical skill to perform, whereas open surgery results in larger wounds and longer hospitalization for recovery. Precise location of colonic polyps is a critical aspect but is difficult to establish during surgery. Although techniques such as localization by endoscopically placed clips, radiographic and magnetic imaging, and intraoperative colonoscopy have all been suggested, surgical localization is optimized by endoscopically placing a four-quadrant tattoo with India ink before surgery. It has been established that preoperative endoscopic tattooing is efficient and reliable for localizing polypectomy sites at operation with successfully visualized tattoos in 88–97% of cases; however, the injection of an optimal volume of India ink into the submucosa is difficult: Too much ink or an injection too deep dyes the whole peritoneum, obscuring the location of the polypectomy site. Herein, we developed a simple method composed of preoperative colonoscopic localization of the sites of polyps by means of transabdominal illumination to mark the sites of incision on the day before the planned operation. The following transcolonic polypectomy or partial colectomy were executed through a minilaparotomy depending on the results of the frozen section. This method has advantages of a short time of recovery of bowel function and consequent short hospital stay, as well as no additional instruments are required for the tumor site detection. From May 2006 to February 2007, a total of 20 consecutive patients underwent resection of colonic polyps at the Department of Surgery of Kaohsiung Medical University Hospital. The colonic polyps were either hard to approach, potentially malignant polyps, too large for snare resection, or had a high possibility of leading to complications of bleeding or perforation and were conseInt J Colorectal Dis (2008) 32:213–214 DOI 10.1007/s00384-007-0363-2