Original technique for small colorectal tumor localization during laparoscopic surgery

INTRODUCTION: Small colonic tumor localization and correct extension of col onic resection is critical in laparoscopic surgery. Currently used techniqu es are sometimes inconclusive and may carry some morbidity. We describe an original method of small tumor localization during laparoscopic colorectal operations through the use of preoperative clip applications by colonoscopy and intraoperative ultrasound of the colon. METHODS: Eight patients with s mall colonic lesions necessitating preoperative marking were included into this study. A two-step technique was used. Before the operation two metal c lips were endoscopically applied proximally and distally to the lesion site . At surgery an intraoperative ultrasound examination of the colon or rectu m surface was performed to localize the clips. Subsequent laparoscopic colo n resection was performed. RESULTS: Endoscopic metallic clips were easily a pplied around the lesion in all cases without complications. No dislodgemen t of clips was documented. At surgery laparoscopic ultrasound visualized th e clips in ail cases. The examination took between 5 and 17 minutes with no specific morbidity. The lesions with the surrounding clips were always fou nd in the resected specimen. CONCLUSIONS: Endoscopic metal clipping and int raoperative laparoscopic ultrasound proved to be an easy, safe, and accurat e technique in locating small colonic tumors.