Surgical Endoscopy

, Volume 22, Issue 2, pp 501–505 | Cite as

The usefulness of preoperative colonoscopic tattooing using a saline test injection method with prepackaged sterile India ink for localization in laparoscopic colorectal surgery

  • J. W. Park
  • D. K. Sohn
  • C. W. Hong
  • K. S. Han
  • D. H. Choi
  • H. J. Chang
  • S.-B. Lim
  • H. S. Choi
  • S.-Y. Jeong



Laparoscopic surgery for colorectal neoplasm requires precise tumor localization. The authors have assessed the safety and efficacy of colonoscopic tattooing using a saline test injection method with prepackaged sterile India ink for tumor localization in laparoscopic colorectal surgery.


Between July 2004 and January 2007, 63 patients underwent colonoscopic tattooing using prepackaged sterile India ink before laparoscopic surgery of colorectal tumors. Patient medical records and operation videos were retrospectively assessed.


Tattoos were visualized intraoperatively in 62 (98.4%) of the 63 patients, and colorectal tumors were accurately localized in 61 patients (96.8%). In one patient, the tattoo could not be detected, whereas in another patient, it was visualized but the serosal surface of the rectosigmoid colon was stained diffusely. Both of these patients underwent intraoperative colonoscopy. Localized leakages of ink were identified in six patients (9.5%) during surgery. However, five of these patients had no symptoms, and the sixth patient, who underwent polypectomy and tattooing simultaneously, felt mild chilling without fever or abdominal pain.


Preoperative colonoscopic tattooing using a saline test injection method with prepackaged sterile India ink is a safe and effective method for tumor localization in laparoscopic colorectal surgery.


Colonoscopy Colorectal neoplasms India ink Laparoscopy Tattooing 


  1. 1.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229CrossRefPubMedGoogle Scholar
  2. 2.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  3. 3.
    Frager DH, Frager JD, Wolf EL, Beneventano TC (1987) Problems in the colonoscopic localization of tumors: continued value of the barium enema. Gastrointest Radiol 12:343–346CrossRefPubMedGoogle Scholar
  4. 4.
    Montorsi M, Opocher E, Santambrogio R, Bianchi P, Faranda C, Arcidiacono P, Passoni GR, Cosentino F (1999) Original technique for small colorectal tumor localization during laparoscopic surgery. Dis Colon Rectum 42:819–822CrossRefPubMedGoogle Scholar
  5. 5.
    Ohdaira T, Konishi F, Nagai H, Kashiwagi H, Shito K, Togashi K, Kanazawa K (1999) Intraoperative localization of colorectal tumors in the early stages using a marking clip detector system. Dis Colon Rectum 42:1353–1355CrossRefPubMedGoogle Scholar
  6. 6.
    Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, Wexner SD (2002) Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc 16:808–811CrossRefPubMedGoogle Scholar
  7. 7.
    Sauntry JP, Knudtson KP (1958) A technique for marking the mucosa of the gastrointestinal tract after polypectomy. Cancer 11:607–610CrossRefPubMedGoogle Scholar
  8. 8.
    Ponsky JL, King JF (1975) Endoscopic marking of colonic lesions. Gastrointest Endosc 22:42–43CrossRefPubMedGoogle Scholar
  9. 9.
    Botoman VA, Pietro M, Thirlby RC (1994) Localization of colonic lesions with endoscopic tattoo. Dis Colon Rectum 37:775–776CrossRefPubMedGoogle Scholar
  10. 10.
    McArthur CS, Roayaie S, Waye JD. (1999) Safety of preoperation endoscopic tattoo with India ink for identification of colonic lesions. Surg Endosc 13:397–400CrossRefPubMedGoogle Scholar
  11. 11.
    Fu KI, Fujii T, Kato S, Sano Y, Koba I, Mera K, Saito H, Yoshino T, Sugito M, Yoshida S (2001) A new endoscopic tattooing technique for identifying the location of colonic lesions during laparoscopic surgery: a comparison with the conventional technique. Endoscopy 33:687–691CrossRefPubMedGoogle Scholar
  12. 12.
    Feingold DL, Addona T, Forde KA, Arnell TD, Carter JJ, Huang EH, Whelan RL (2004) Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. J Gastrointest Surg 8:543–546CrossRefPubMedGoogle Scholar
  13. 13.
    Askin MP, Waye JD, Fiedler L, Harpaz N (2002) Tattoo of colonic neoplasms in 113 patients with a new sterile carbon compound. Gastrointest Endosc 56:339–342CrossRefPubMedGoogle Scholar
  14. 14.
    Larach SW, Salomon MC, Williamson PR, Goldstein E (1993) Laparoscopic assisted colectomy: experience during the learning curve. Coloproctology 1:38–41Google Scholar
  15. 15.
    Kim SH, Milsom JW, Church JM, Ludwig KA, Garcia-Ruiz A, Okuda J, Fazio VW (1997) Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc 11:1013–1016CrossRefPubMedGoogle Scholar
  16. 16.
    Hammond DC, Lane FR, Welk RA, Madura MJ, Borreson DK, Passinault WJ (1989) Endoscopic tattooing of the colon: an experimental study. Am Surg 55:457–461PubMedGoogle Scholar
  17. 17.
    Hammond DC, Lane FR, Mackeigan JM, Passinault WJ (1993) Endoscopic tattooing of the colon: clinical experience. Am Surg 59:205–210PubMedGoogle Scholar
  18. 18.
    Price N, Gottfried MR, Clary E, Lawson DC, Baillie J, Mergener K, Westcott C, Eubanks S, Pappas TN (2000) Safety and efficacy of India ink and indocyanine green as colonic tattooing agents. Gastrointest Endosc 51:438–442CrossRefPubMedGoogle Scholar
  19. 19.
    Shatz BA, Weinstock LB, Swanson PE, Thyssen EP (1997) Long-term safety of India ink tattoos in the colon. Gastrointest Endosc 45:153–156CrossRefPubMedGoogle Scholar
  20. 20.
    Fennerty MB, Sampliner RE, Hixson LJ, Garewal HS (1992) Effectiveness of India ink as a long-term colonic mucosal marker. Am J Gastroenterology 87:79–81Google Scholar
  21. 21.
    Nizam R, Siddiqi N, Landas SK, Kaplan DS, Holtzapple PG (1996) Colonic tattooing with India ink: benefits, risks, and alternatives. Am J Gastroenterol 91:1804–1808PubMedGoogle Scholar
  22. 22.
    Park SI, Genta RS, Romeo DP, Weesner RE (1991) Colonic abscess and focal peritonitis secondary to India ink tattooing of the colon. Gastrointest Endosc 37:68–71CrossRefPubMedGoogle Scholar
  23. 23.
    Hornig D, Kuhn H, Stadelmann O, Botticher R (1983) Phlegmonous gastritis after India Ink marking. Endoscopy 15:266–269CrossRefPubMedGoogle Scholar
  24. 24.
    Coman E, Brandt LJ, Brenner S, Frank M, Sablay B, Bennett B (1991) Fat necrosis and inflammatory pseudotumor due to endoscopic tattooing of the colon with India ink. Gastrointest Endosc 37:65–68CrossRefPubMedGoogle Scholar
  25. 25.
    Lightdale CJ (1991) India ink colonic tattoo: blots on the record. Gastrointest Endosc 37:68–71CrossRefGoogle Scholar
  26. 26.
    Kim DW, Sohn DK, Choi HS, Chang HJ, Han KS, Lim SB, Chung SY, Park JG (2006) Safety and efficacy of colonoscopic tattooing of a colorectal neoplasm prior to a laparoscopic resection (in Korean). J Korean Soc Coloproctol 22:97–102Google Scholar
  27. 27.
    Arteaga-González I, Martín-Malagón A, Fernández EM, Arranz-Durán J, Parra-Blanco A, Nicolas-Perez D, Quintero-Carrión E, Luis HD, Carrillo-Pallares A (2006) The use of preoperative endoscopic tattooing in laparoscopic colorectal cancer surgery for endoscopically advanced tumors: a prospective comparative clinical study. World J Surg 30:605–611CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • J. W. Park
    • 1
  • D. K. Sohn
    • 1
  • C. W. Hong
    • 1
  • K. S. Han
    • 1
  • D. H. Choi
    • 1
  • H. J. Chang
    • 1
  • S.-B. Lim
    • 1
  • H. S. Choi
    • 1
  • S.-Y. Jeong
    • 1
  1. 1.Center for Colorectal CancerResearch Institute and Hospital, National Cancer CenterGoyangKorea

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