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Perioperative tumor localization for laparoscopic colorectal surgery
S H Kim1, J W Milsom, J M Church
1Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
Surgical Endoscopy
|October 8, 1997
Summary
Accurate preoperative colonoscopy is crucial for locating colonic tumors during laparoscopic surgery. Reliable tumor identification allows for precise resection, preventing incorrect segment removal and ensuring adequate margins.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Minimally Invasive Procedures
Background:
- Palpating colonic tumors during laparoscopy is challenging.
- Precise tumor localization is essential before laparoscopic colorectal resection.
Purpose of the Study:
- To describe methods for tumor localization in laparoscopic colorectal surgery.
- To evaluate the effectiveness of these localization techniques.
Main Methods:
- Retrospective study of 58 patients undergoing laparoscopic colorectal operations.
- Preoperative colonoscopy for all patients.
- Various intraoperative localization techniques including tattooing, intraoperative colonoscopy, and proctoscopy with suturing.
Main Results:
- Preoperative colonoscopy accurately identified tumors in most cases, enabling resection without marking, especially for lesions near the ileocecal valve.
- Intraoperative localization methods had varying success rates and complications, such as poor visualization or dislodged clips.
- No patients had tumors at resection lines or underwent resection of the wrong segment.
Conclusions:
- Preoperative colonoscopy is reliable for identifying tumors adjacent to the ileocecal valve, potentially obviating the need for intraoperative marking.
- Intraoperative proctoscopy with suture placement is effective for upper rectal lesions.
- Preoperative tattooing is recommended for lesions other than rectal or cecal if intraoperative localization is anticipated to be difficult.