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The Role of Endoscopic Tattooing in Colorectal Surgery

Nikola Boyanov, Asen Yotovski, Katina Shtereva, Neno Shopov, Luben Kirkov, Katerina Madzharova, Aleksandar Balabanski


The intraoperative finding of a lesion, which has already been located previously by endoscopy, can sometimes be a challenge, especially during laparoscopy. Failure to locate the exact place of the lesion can cause the resection of a wrong bowel segment. Endoscopic submucosal tattooing is a minimally invasive technique, allowing marking of a carcinoma or polyp that is not suitable for endoscopic mucosal resection (EMR) in the colon.

During a colonoscopy for marking a certain spot, we use 0.5–1.0 mL of submucosal solution of indigo ink. Injecting the substance causes a dark mark, which is visible in the peritoneal cavity during surgery. The risks of this manipulation are coloring the peritoneum and other structures and organs outside the colon such as kidneys, omentum, stomach, or a part of the intestines. This can be avoided using the proper technique of injection. There are no strict rules of execution of the manipulation. The approach is individual and depends on the endoscopist and the location of the lesion. Frequently used methods are circular marking of the affected area and placement of the ink distally and/or proximally of the lesion.

In conclusion, tattooing reduces time in the operating room, lowers the risk of healthy bowel resection and aids in faster finding of the exact location of the lesion. The procedure is easily executed by an experienced endoscopist and does not carry a significant risk of complications.

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About The Authors

Nikola Boyanov
Medical University of Plovdiv

Medical Simulation Training Center at Research Institute of Medical University of Plovdiv;

Department of Gastroenterology, Pulmed University Hospital, Plovdiv

Asen Yotovski
Department of Gastroenterology, Pulmed University Hospital, Plovdiv

Katina Shtereva
Department of Gastroenterology, Pulmed University Hospital, Plovdiv

Neno Shopov
Department of Surgery, Pulmed University Hospital, Plovdiv

Luben Kirkov
Department of Gastroenterology, Pulmed University Hospital, Plovdiv

Katerina Madzharova
Department of Gastroenterology, Pulmed University Hospital, Plovdiv

Aleksandar Balabanski
Department of Gastroenterology, Pulmed University Hospital, Plovdiv

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