Preoperative Indocyanine Green Tattooing for Robotic-Assisted Surgery in Rectal Cancer

Abstract

Introduction: Preoperative identification of the site of rectal cancer surgery is crucial for ensuring accurate tumor localization and resection. Commonly employed methods include contrast-enhanced enterography and endoscopic marking techniques, such as clipping and India ink tattooing. However, India ink tattooing poses challenges, including obstruction of the surgical field, ink leakage into the abdominal cavity, and potential complications such as peritonitis and adhesive bowel obstruction. Similarly, clipping requires palpation, making minimally invasive procedures, such as laparoscopic or robotic-assisted surgery, impractical.

Materials and surgical technique: The indocyanine green fluorescence method is employed intraoperatively to monitor blood and lymph flow in the intestinal tract. Here, we discuss the effectiveness of preoperative indocyanine green marking in accurately locating tumors during robot-assisted rectal colorectal surgery.

Discussion: By using the fluorescence properties of indocyanine green, surgeons can precisely identify the tumor site, overcoming the limitations of traditional methods. This technique improves surgical accuracy while minimizing intraoperative risks and achieving optimal oncological outcomes. Preoperative indocyanine green tattooing represents a valuable enhancement to current techniques in rectal cancer surgery, particularly for robot-assisted approaches. Our findings underscore the applicability of preoperative indocyanine green tattooing as a promising alternative in robot-assisted surgery for patients with rectal cancer.

Keywords: indocyanine green fluorescence dye; rectal cancer; robotic‐assisted surgery.