Skip to main content

Advertisement

SpringerLink
Log in

Intraoperative localization of occult colorectal tumors during laparoscopic surgery by magnetic ring markers—a pilot study

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Intraoperative localization of small tumors or malignant polyps has been an important issue in laparoscopic colon surgery. We have developed a new method for preoperative endoscopic tumor marking using a ring-shaped magnetic marker.

Methods

In a pilot study, 28 patients with small colonic (n = 23) or rectal tumors (n = 5) underwent endoscopic magnetic clipping prior to laparoscopic resection. A cap carrying a high-power neodymium ring magnet was mounted on the tip of a colonoscope. Near the lesion, the ring magnet was released and clipped to the colorectal wall. Standard laparoscopic instruments were used to find the magnet intraoperatively.

Results

Endoscopic fixation of a ring magnet next to the tumor by clipping was technically feasible in all 28 patients. Intraoperative localization of the marked lesions was successful in 27 of 28 patients (96 %). All patients underwent magnet-guided radical laparoscopic resection of the tumor with an average proximal and distal resection margin of 101 and 63 mm, respectively. In one case, the magnet could not be found due to preoperative migration. Surgical complications related to magnetic clip application or intraoperative tumor localization were not observed. However, there was one case with an intraoperative perforation of the colon by the magnet, which was obviously caused by unchecked action with a laparoscopic instrument.

Conclusions

Preoperative endoscopic labeling of colonic lesions with on-the-scope magnetic markers is simple and safe. Intraoperative tumor localization during laparoscopic colorectal surgery can be achieved reliably without additional equipment such as ultrasound or fluoroscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hannan EL, Imperato PJ, Nenner RP, Starr H (1999) Laparoscopic and open cholecystectomy in New York State: mortality, complications, and choice of procedure. Surgery 125(2):223–231

    Article  PubMed  CAS  Google Scholar 

  2. Ingraham AM, Cohen ME, Bilimoria KY, Pritts TA, Ko CY, Esposito TJ (2010) Comparison of outcomes after laparoscopic versus open appendectomy for acute appendicitis at 222 ACS NSQIP hospitals. Surgery 148(4):625–635, Discussion, 635–627

    Article  PubMed  Google Scholar 

  3. McCloskey CA, Wilson MA, Hughes SJ, Eid GM (2007) Laparoscopic colorectal surgery is safe in the high-risk patient: a NSQIP risk-adjusted analysis. Surgery 142(4):594–597, Discussion, 597, e591–592

    Article  PubMed  Google Scholar 

  4. Pendlimari R, Holubar SD, Pattan-Arun J, Larson DW, Dozois EJ, Pemberton JH, Cima RR (2010) Hand-assisted laparoscopic colon and rectal cancer surgery: feasibility, short-term, and oncological outcomes. Surgery 148(2):378–385

    Article  PubMed  Google Scholar 

  5. 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 randomised trial. Lancet 359(9325):2224–2229

    Article  PubMed  Google Scholar 

  6. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059

    Article  Google Scholar 

  7. Kavanagh DO, Gibson D, Moran DC, Smith M, OD K, Eguare E, Keane FB, DS OR, Neary PC (2011) Short-term outcomes following laparoscopic resection for colon cancer. Int J Color Dis 26(3):361–368

    Article  Google Scholar 

  8. Li JC, Leung KL, Ng SS, Liu SY, Lee JF, Hon SS (2012) Laparoscopic-assisted versus open resection of right-sided colonic cancer—a prospective randomized controlled trial. Int J Colorectal Dis 27:95–102

    Article  PubMed  Google Scholar 

  9. Hoffman GC, Baker JW, Fitchett CW, Vansant JH (1994) Laparoscopic-assisted colectomy. Initial experience. Ann Surg 219(6):732–740, Discussion, 740–733

    Article  PubMed  CAS  Google Scholar 

  10. Wexner SD, Cohen SM, Ulrich A, Reissman P (1995) Laparoscopic colorectal surgery—are we being honest with our patients? Dis Colon Rectum 38(7):723–727

    Article  PubMed  CAS  Google Scholar 

  11. Corbitt JD Jr (1992) Preliminary experience with laparoscopic-guided colectomy. Surg Laparosc Endosc 2(1):79–81

    PubMed  Google Scholar 

  12. Aboosy N, Mulder CJ, Berends FJ, Meijer JW, Sorge AA (2005) Endoscopic tattoo of the colon might be standardized to locate tumors intraoperatively. Rom J Gastroenterol 14(3):245–248

    PubMed  Google Scholar 

  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(3):339–342

    Article  PubMed  Google Scholar 

  14. Cho YB, Lee WY, Yun HR, Lee WS, Yun SH, Chun HK (2007) Tumor localization for laparoscopic colorectal surgery. World J Surg 31(7):1491–1495

    Article  PubMed  Google Scholar 

  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(10):1013–1016

    Article  PubMed  CAS  Google Scholar 

  16. Park JW, Sohn DK, Hong CW, Han KS, Choi DH, Chang HJ, Lim SB, Choi HS, Jeong SY (2008) The usefulness of preoperative colonoscopic tattooing using a saline test injection method with prepackaged sterile India ink for localization in laparoscopic colorectal surgery. Surg Endosc 22(2):501–505

    Article  PubMed  CAS  Google Scholar 

  17. 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(5):543–546

    Article  PubMed  Google Scholar 

  18. Nagata K, Endo S, Tatsukawa K, Kudo SE (2008) Intraoperative fluoroscopy vs. intraoperative laparoscopic ultrasonography for early colorectal cancer localization in laparoscopic surgery. Surg Endosc 22(2):379–385

    Article  PubMed  Google Scholar 

  19. Hyung WJ, Lim JS, Cheong JH, Kim J, Choi SH, Song SY, Noh SH (2005) Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy. Surg Endosc 19(10):1353–1357

    Article  PubMed  CAS  Google Scholar 

  20. Hyung WJ, Lim JS, Cheong JH, Lee YC, Noh SH (2004) Tumor localization using laparoscopic ultrasound for a small submucosal tumor. J Surg Oncol 86(3):164–166

    Article  PubMed  Google Scholar 

  21. Tomita H, Marcello PW, Milsom JW (1999) Laparoscopic surgery of the colon and rectum. World J Surg 23(4):397–405

    Article  PubMed  CAS  Google Scholar 

  22. Tan WS, Chew MH, Ooi BS, Ng KH, Lim JF, Ho KS, Tang CL, Eu KW (2009) Laparoscopic versus open right hemicolectomy: a comparison of short-term outcomes. Int J Color Dis 24(11):1333–1339

    Article  Google Scholar 

  23. Yun HR, Cho YK, Cho YB, Kim HC, Yun SH, Lee WY, Chun HK (2010) Comparison and short-term outcomes between hand-assisted laparoscopic surgery and conventional laparoscopic surgery for anterior resections of left-sided colon cancer. Int J Color Dis 25(8):975–981

    Article  Google Scholar 

  24. 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(4):343–346

    Article  PubMed  CAS  Google Scholar 

  25. Larach SW, Salomon MC, Williamson PR, Goldstein E (1993) Laparoscopic assisted abdominoperineal resection. Surg Laparosc Endosc 3(2):115–118

    PubMed  CAS  Google Scholar 

  26. Winter H, Lang RA, Spelsberg FW, Jauch KW, Huttl TP (2007) Laparoscopic colonoscopic rendezvous procedures for the treatment of polyps and early stage carcinomas of the colon. Int J Color Dis 22(11):1377–1381

    Article  CAS  Google Scholar 

  27. Ghahremanlou R, Bulut O, Jess P (2005) Localization of colonic tumor in laparoscopic surgery. Intraoperative colonoscopy or preoperative tattoo. Ugeskr Laeger 167(32):2886–2889

    PubMed  Google Scholar 

  28. 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(1):65–68

    Article  PubMed  CAS  Google Scholar 

  29. 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(6):819–822

    Article  PubMed  CAS  Google Scholar 

  30. 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(10):1353–1355

    Article  PubMed  CAS  Google Scholar 

  31. Ohdaira T, Nagai H, Shoji M (2003) Intraoperative localization of colorectal tumors in the early stages using a magnetic marking clip detector system (MMCDS). Surg Endosc 17(5):692–695

    Article  PubMed  CAS  Google Scholar 

  32. Cope C, Ginsberg GG (2001) Long-term patency of experimental magnetic compression gastroenteric anastomoses achieved with covered stents. Gastrointest Endosc 53(7):780–784

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery and Surgical Oncology, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Sören Kneif & Michael Hünerbein

  2. Department of General, Visceral and Transplantation Surgery, Charité—Campus Virchow Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Peter Warnick & Sascha S. Chopra

  3. Department of Gastroenterology, Helios Hospital Berlin, Berlin, Germany

    Matthias Raubach

Authors
  1. Peter Warnick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sascha S. Chopra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Raubach
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sören Kneif
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Hünerbein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Hünerbein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Warnick, P., Chopra, S.S., Raubach, M. et al. Intraoperative localization of occult colorectal tumors during laparoscopic surgery by magnetic ring markers—a pilot study. Int J Colorectal Dis 28, 795–800 (2013). https://doi.org/10.1007/s00384-012-1579-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-012-1579-3

Keywords

Search

Navigation