title: Effect of types of resection and manipulation on trocar site contamination after laparoscopic colectomy: An experimental study in rats with intraluminal radiotracer application.
abstract: BACKGROUND
  The etiology and incidence of port-site metastases after laparoscopic surgery for colorectal cancer remain unknown. The purpose of this experimental study was to detect and quantify the amount of contamination at the port-site by means of a method utilizing radiolabelled colloid particles following extra- or intracorporeal laporoscopic resection of cecum.
  
  
  METHODS
  Prior to experimental surgery, we obtained a high concentration of luminal colonic radiotracer activity by per anum application of sulphur colloid molecules labelled with Tc-99m pertechnetate. In three main groups of rats, we either resected a portion of cecum extracorporeally or intracorporeally, or did no resection. Each main group was further divided into two subgroups, in which the manipulations were either autraumatic or traumatic. We excised trocar sites as 2 cm doughnuts after completion of the surgical procedure. We used gamma camera imaging to quantify the amount of radioactive contamination at trocar sites. The background corrected trocar site activity for each rat was calculated. Activities exceeding the maximum background activity were accepted as trocar site contamination.
  
  
  RESULTS
  We detected an overall incidence of contamination in 44% of rats. This rate were 71% and 17% in traumatic and atraumatic subgroups. The resection itself increased the rate and intensity of contamination, as well (p = 0.04). The most intensive contamination was detected in the intracorporeal resection with traumatic manipulation subgroup (p = 0.0007).
  
  
  CONCLUSIONS
  Both the presence of resection and manipulative trauma seemed to be increasing the rate and intensity of the radioactive activity at the trocar site. When traumatic manipulatiun was exercised, the contamination was so intense that the type of resection did not differ. We concluded that our scintigraphic method would be useful in the intraoperative detection of port site contamination by the tumor cells, and that surgeons would take some preventive measures to prevent future port-site metastases.
authors: General surgery, Samsun Devlet Hastanesi, Samsun, Turkey. ayferkp@yahoo.com
authors: Ayfer Kamali
authors: AK
authors: Polat
authors: Oktay
authors: O
authors: Yapici
authors: Zafer
authors: Z
authors: Malazgirt
authors: Tarik
authors: T
authors: Basoglu
mesh_terms: D000008:Abdominal Neoplasms / Q000209:etiology / Q000556:secondary; D034861:Abdominal Wall / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000818:Animals; D003082:Colectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D003102:Colloids; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D004195:Disease Models, Animal; D004866:Equipment Contamination / Q000517:prevention & control*; D007049:Iatrogenic Disease / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D009366:Neoplasm Seeding; D011877:Radionuclide Imaging; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012007:Rectum / Q000000981:diagnostic imaging* / Q000601:surgery; D012107:Research Design; D013525:Surgical Instruments / Q000009:adverse effects*; D013667:Technetium
chemical_list: D003102:Colloids; D013667:Technetium
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