Preoperative computerized tomography-guided blue dye localization for metastatic lymphadenopathy and peritoneal tumor implants during laparoscopic surgery

Abstract

Rationale: Computerized tomography (CT)-guided blue dye localization has been widely discussed for preoperative localization of pulmonary nodules. However, few studies have investigated this technique for intra-abdominal lesions. Although preoperative localization is not commonly required in laparotomy, it may assume importance with advancements in the field of laparoscopic surgery. Patient concerns: Herein, we report the cases of 2 patients diagnosed with colon cancer who underwent hemicolectomy with extended lymphadenectomy and subsequent chemotherapy. Diagnoses: Follow-up CT scans showed newly developed metastatic lymphadenopathy and peritoneal tumor implants. Interventions: Considering the difficulty in identification of and access to the target lesions during laparoscopic surgery, preoperative CT-guided blue dye localization was performed in both cases. Outcomes: All the target lesions were identified by the dye marker and removed successfully. The pathologic results revealed adenocarcinoma. Lessons: We established the following strategy for preoperative CT-guided dye localization of intra-abdominal lesions: Intra-abdominal lesions that are hard to identify due to their size or morphology, and difficult to approach due to their location or surrounding structures, maybe the candidates for this procedure, especially in cases of laparoscopic surgery. Operators should adjust their localization planning based on the surgery method, cutting path, and location of port sites. The target dye marker should be clearly visible in the presumed intra-operative field of view. A second dye marker should be made to ensure surgical success when the target dye marker is obscured by the surrounding structures in the presumed intra-operative field of view.

Marcación prequirúrgica de ganglio hipogástrico con tomografía computada asistido por hidrodisección

“…No obstante, su uso en el abdomen y la pelvis probablemente esté sub estudiado debido a que la mayor parte de las lesiones son fácilmente identificables en la cirugía. Sin embargo algunas de ellas pueden ser de difícil localización, más aún durante cirugías laparoscópicas motivo por el cual se opta por la marcación con guía imagenológica para facilitar su extracción 4 .…”

“…No obstante, su uso en el abdomen y la pelvis probablemente esté sub estudiado debido a que la mayor parte de las lesiones son fácilmente identificables en la cirugía. Sin embargo algunas de ellas pueden ser de difícil localización, más aún durante cirugías laparoscópicas motivo por el cual se opta por la marcación con guía imagenológica para facilitar su extracción (4) . Los accesos transóseos permiten alcanzar lesiones profundas o aquellas que se encuentran bloqueadas por estructuras nobles y que no son accesibles mediante abordajes tradicionales (distancia más corta entre piel y objetivo) (5)(6) .…”