title: Preoperative endoscopic tattooing of pancreatic body and tail lesions decreases operative time for laparoscopic distal pancreatectomy.
abstract: BACKGROUND
  Precise and expedient localization of small pancreatic tumors during laparoscopic distal pancreatectomy can be difficult owing to the decreased tactile ability of laparoscopy and the homogenous appearance of the surrounding retroperitoneal fat. Precise localization of the lesion is critical to achieving adequate margins of resection while preserving as much healthy pancreas as possible. The objective in this study was to determine the effect of endoscopic tattooing of the distal pancreas on operative time.
  
  
  METHODS
  We reviewed retrospectively 36 consecutive patients who had a laparoscopic distal pancreatectomy at our institution over a 4-year period (2006-2009). Ten patients underwent preoperative tattooing via an endoscopic transgastric technique using ultrasound guidance. The tattoo was performed using 2-4 cc of sterile purified carbon particles injected immediately proximal and anterior to the pancreatic lesion. Operative times were compared according to the presence of a tattoo.
  
  
  RESULTS
  The endoscopically placed tattoo was easily visible upon entering the lesser sac in all 10 patients at laparoscopy. Patients with a tattoo had a shorter operative time (median, 128.5 minutes; range, 53-180) compared with patients without a tattoo (median, 180 minutes; range, 120-240; P < .01). None of the tattoo group required repeat surgery, whereas 1 patient who was not tattooed required re-resection for a lesion missed in the initial specimen. There were no complications associated with the endoscopic ultrasound-guided tattoo.
  
  
  CONCLUSIONS
  Endoscopic ultrasound-guided tattooing of pancreas lesions before a laparoscopic distal pancreatectomy is safe and is associated with decreased operative time compared with nontattooed patients. This technique can allow for quick and precise localization of the lesion, allowing for optimal preservation of pancreas parenchyma and demarcating an appropriate line of resection.
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
authors.forename: Naeem A
authors.initials: NA
authors.lastname: Newman
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Marta M
authors.initials: MM
authors.lastname: Gilson
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Giday
authors.forename: Marcia I
authors.initials: MI
authors.lastname: Canto
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000517:prevention & control; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D010529:Peritoneal Cavity / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods; D013653:Tattooing / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D014463:Ultrasonography