Usefulness of colonic tattooing using indocyanine green in patients with colorectal tumors

Abstract

AIMTo prove that tattooing using indocyanine green (ICG) is feasible in laparoscopic surgery for a colon tumor.METHODSFrom January 2012 to December 2016, all patients who underwent laparoscopic colonic surgery were retrospectively screened, and 1010 patients with colorectal neoplasms were included. Their lesions were tattooed with ICG the day before the operation. The tattooed group (TG) included 114 patients, and the non-tattooed group (NTG) was selected by propensity score matching of subjects based on age, sex, tumor staging, and operation method (n = 228). In total, 342 patients were enrolled. Between the groups, the changes in [Delta (Δ), preoperative-postoperative] the hemoglobin and albumin levels, operation time, hospital stay, oral ingestion period, transfusion, and perioperative complications were compared.RESULTSPreoperative TG had a shorter operation time (174.76 ± 51.6 min vs 192.63 ± 59.9 min, P < 0.01), hospital stay (9.55 ± 3.36 d vs 11.42 ± 8.23 d, P < 0.01), and post-operative oral ingestion period (1.58 ± 0.96 d vs 2.81 ± 1.90 d, P < 0.01). The Δ hemoglobin (0.78 ± 0.76 g/dL vs 2.2 ± 1.18 g/dL, P < 0.01) and Δ albumin (0.41 ± 0.44 g/dL vs 1.08 ± 0.39 g/dL, P < 0.01) levels were lower in the TG. On comparison of patients in the “N0” and “N1 or N2” groups, the N0 colon cancer group had a better operation time, length of hospital stay, oral ingestion period, Δ hemoglobin, and Δ albumin results than those of the N1 or N2 group. The operation methods affected the results, and laparoscopic anterior resection (LAR) showed similar results. However, for left and right hemicolectomy, both groups showed no difference in operation time or hospital stay.CONCLUSIONPreoperative tattooing with ICG is useful for laparoscopic colectomy, especially in the N0 colon cancer group and LAR.

Optimal ICG dosage of preoperative colonoscopic tattooing for fluorescence-guided laparoscopic colorectal surgery

“…However, recognizing the location of early-stage tumors using laparoscopic or robotic devices has become challenging [ 1 ]. To overcome the absence of tactile feedback, many intraoperative navigation methods have been introduced, including intraoperative ultrasound, gamma probes, and preoperative endoscopic tumor marking, referred to as “tattooing” [ 1 , 2 ]. Indocyanine green (ICG) is a tricarbocyanine iodide dye molecule that is amphiphilic, relatively non-toxic, and dark blue pigmented substance that can be used as one of good tattooing agents.…”

“…Indocyanine green (ICG) is a tricarbocyanine iodide dye molecule that is amphiphilic, relatively non-toxic, and dark blue pigmented substance that can be used as one of good tattooing agents. ICG is a useful preoperative tattooing agent that fluoresces under near-infrared (NIR) light with a maximum peak wavelength of approximately 830 nm [ 2 , 3 ]. With the use of fluorescence imaging systems, the different dilutions of the ICG can be used to distinguish the colon from the mesentery and visceral fat tissue under NIR illumination [ 4 , 5 ].…”

Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

“…In that setting, endoscopic tattooing of rectal tumors, both with a high-definition fluorescence imaging system (Karl Storz GmbH & Co. KG, Tuttlingen, Germany)[ 93 ] and the PINPOINT ® endoscopic fluorescence imaging system (PINPOINT system; Novadaq Technologies Inc., Mississauga, ON, Canada)[ 99 ], is feasible and has clinical advantages. In a comparative retrospective series, 342 patients scheduled for laparoscopic colorectal resection were enrolled after propensity score matching[ 100 ]. The tumor was tattooed in 114 patients.…”

Multifunctional Indocyanine Green Applications for Fluorescence-Guided Laparoscopic Colorectal Surgery

“…However, the localization of early-stage colorectal cancer is still challenging in the field of minimally invasive surgery without tactile sensation [ 1 ]. To localize the small tumor, many intraoperative navigation methods have been introduced, including intraoperative ultrasound and preoperative endoscopic tattooing [ 2 ].…”