Colonic Tattooing Using Fluorescence Imaging with Light-emitting Diode-activated Indocyanine Green: a Feasibility Study

Overview

Journal Surg Today

Specialty General Surgery

Date 2009 Mar 13

PMID 19280280

Citations 32

Authors

Makoto Watanabe

Akira Tsunoda

Kazuhiro Narita

Mitsuo Kusano

Mitsuharu Miwa

Affiliations

Soon will be listed here.

Abstract

Purpose: We investigated the feasibility of a fluorescence imaging technique using light-emitting diode (LED)-activated indocyanine green (ICG) fluorescence.

Methods: Indocyanine green injections were given to patients undergoing preoperative colonoscopy for early colon cancer or colon adenoma. During subsequent laparotomy, the colon was first observed with the naked eye, and then using a prototype machine with a charge-coupled device (CCD) video camera equipped with a cutoff filter and a LED at a wavelength of 760 nm as the light source.

Results: LED-induced fluorescence showed tumor localization clearly and accurately in all ten patients (100%) enrolled in this study, whereas it was seen with the naked eye as a green spot in only two patients (20%) (P = 0.0077; Wilcoxon's signed-rank test). There were no complications of LED-induced fluorescence and no inflammatory signs were noted on the hematoxylin-eosin-stained slides for the identified injection sites in the resected specimens.

Conclusions: Colonic tattooing using this fluorescence imaging technique of LED-activated ICG fluorescence is a new concept of colonic marking based on the characteristics that ICG is a near infrared fluorescent dye, and is useful, without any adverse effects, to identify perioperatively the tumor localization.

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References

Coman E, Brandt L, Brenner S, Frank M, Sablay B, Bennett B . Fat necrosis and inflammatory pseudotumor due to endoscopic tattooing of the colon with india ink. Gastrointest Endosc. 1991; 37(1):65-8. DOI: 10.1016/s0016-5107(91)70626-3. View

Lane K, Vallera R, Washington K, Gottfried M . Endoscopic tattoo agents in the colon. Tissue responses and clinical implications. Am J Surg Pathol. 1996; 20(10):1266-70. DOI: 10.1097/00000478-199610000-00013. View

Botoman V, Pietro M, Thirlby R . Localization of colonic lesions with endoscopic tattoo. Dis Colon Rectum. 1994; 37(8):775-6. DOI: 10.1007/BF02050141. View

Taggart D, Choudhary B, Anastasiadis K, Abu-Omar Y, Balacumaraswami L, Pigott D . Preliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization. Ann Thorac Surg. 2003; 75(3):870-3. DOI: 10.1016/s0003-4975(02)04669-6. View

Lee J, Low A, Leung J . Randomized comparative study of indocyanine green and India ink for colonic tattooing: an animal survival study. J Clin Gastroenterol. 2000; 31(3):233-6. DOI: 10.1097/00004836-200010000-00010. View

Bilchik A, Trocha S . Lymphatic mapping and sentinel node analysis to optimize laparoscopic resection and staging of colorectal cancer: an update. Cancer Control. 2003; 10(3):219-23. DOI: 10.1177/107327480301000305. View

Choi Y, Lee S, Lee T, Kim S, Cheon G, Kang S . Economic outcomes of laparoscopic versus open surgery for colorectal cancer in Korea. Surg Today. 2007; 37(2):127-32. DOI: 10.1007/s00595-006-3356-9. View

Kitai T, Inomoto T, Miwa M, Shikayama T . Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer. 2005; 12(3):211-5. DOI: 10.2325/jbcs.12.211. View

Ponsky J, King J . Endoscopic marking of colonic lesions. Gastrointest Endosc. 1975; 22(1):42-3. DOI: 10.1016/s0016-5107(75)73687-8. View

10.

Kusano M, Tajima Y, Yamazaki K, Kato M, Watanabe M, Miwa M . Sentinel node mapping guided by indocyanine green fluorescence imaging: a new method for sentinel node navigation surgery in gastrointestinal cancer. Dig Surg. 2008; 25(2):103-8. DOI: 10.1159/000121905. View

11.

Hammond D, LANE F, Welk R, Madura M, Borreson D, Passinault W . Endoscopic tattooing of the colon. An experimental study. Am Surg. 1989; 55(7):457-61. View

12.

Bahadursingh A, Driver M, Koenig C, Longo W . Inadvertent transmural India ink tattooing simulating intestinal infarction. Am J Surg. 2003; 185(1):88-9. DOI: 10.1016/s0002-9610(02)01113-3. View

13.

Hellmig S, Stuber E, Kiehne K, Kosmahl M, Folsch U . What do we really know about the long-term safety of colonic tattooing?. Gastrointest Endosc. 2005; 61(1):186-7. DOI: 10.1016/s0016-5107(04)02464-2. View

14.

Yano H, Okada K, Monden T . Adhesion ileus caused by tattoo-marking: unusual complication after laparoscopic surgery for early colorectal cancer. Dis Colon Rectum. 2003; 46(7):987. DOI: 10.1007/s10350-004-6699-6. View

15.

Price N, Gottfried M, Clary E, Lawson D, Baillie J, Mergener K . Safety and efficacy of India ink and indocyanine green as colonic tattooing agents. Gastrointest Endosc. 2000; 51(4 Pt 1):438-42. DOI: 10.1016/s0016-5107(00)70445-7. View

16.

Gianom D, Hollinger A, Wirth H . [Intestinal perforation after preoperative colonic tattooing with India ink]. Swiss Surg. 2004; 9(6):307-10. DOI: 10.1024/1023-9332.9.6.307. View