title: Novel technique for intraoperative tumor localization during totally laparoscopic distal gastrectomy: endoscopic autologous blood tattooing.
abstract: BACKGROUND
  Knowledge of the intraoperative location of lesions is a prerequisite for deciding the proper extent of gastric resection or the choice of anastomosis technique during totally laparoscopic distal gastrectomy (TLDG) for early gastric cancer (EGC). In this study we introduce a novel tumor localization method for TLDG: endoscopic blood tattooing.
  
  
  METHODS
  Twenty-three consecutive patients scheduled for TLDG for EGC were enrolled in this prospective study. The day before surgery, 2-3 ml of autologous blood was injected into the gastric muscle layer at 3-4 cm proximal to the lesion during endoscopy.
  
  
  RESULTS
  The study subjects consisted of 15 males and 8 females with a mean age of 61 ± 10.4 years. During surgery, the endoscopic blood tattooed sites were successfully identified in all 23 patients. No complications associated with the procedure occurred, and no patient had microscopic residual tumor cells at the proximal resection margin, with a mean proximal margin length of 3.3 ± 2.7 cm. Eighteen patients underwent TLDG with Billroth II anastomosis, four patients with Roux-en-Y gastrojejunostomy, and one patient with laparoscopic total gastrectomy. At final pathologic examinations, 20 patients were of stage IA and 3 were of stage IB according to the UICC TNM classification (6th ed.).
  
  
  CONCLUSIONS
  Endoscopic blood tattooing provides a simple and useful means of localizing lesions during TLDG for EGC. Although the superiority of this technique over other localization methods needs to be evaluated further, the authors recommend endoscopic blood tattooing as an alternative to other intraoperative localization methods for laparoscopic surgery for EGC.
authors.affiliation: Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea.
authors.forename: Oh
authors.initials: O
authors.lastname: Jeong
authors.forename: Sung Bum
authors.initials: SB
authors.lastname: Cho
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Joo
authors.forename: Seong Yeob
authors.initials: SY
authors.lastname: Ryu
authors.forename: Young Kyu
authors.initials: YK
authors.lastname: Park
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001804:Blood Transfusion, Autologous / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D013194:Staining and Labeling / Q000379:methods; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013653:Tattooing / Q000379:methods*