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India ink tattoo injection1/8/2024 2 Currently, most data strongly support the use of permanent endoscopic tattoos as the most effective means to ensure accurate intraoperative detection of colorectal lesions. 2 Usage of clips is unreliable due to poor visualisation and clip migration. 3, 4 Intraoperative colonoscopy prolongs operative time, is technically challenging and may lead to postoperative complications due to bowel distension. 2, 3 Barium enemas are poor at visualising small or flat tumours. Methods that have been used historically include preoperative barium enemas, colonoscopy with clip or tattoo, CT scans, CT colonography, intraoperative colonoscopy with clip or tattoo, and proctoscopy with stitch. 2 Thus, a precise tumour localising method is essential for laparoscopic colorectal tumour resection and obtaining the necessary margins. Inaccurate tumour localisations have led to reports of laparoscopic resection of the wrong segment of colon, requiring conversion to open laparotomy and additional resection. However, these methods are limited because patients may have redundant colonic loops that make anatomical measurements challenging and inaccurate. Endoscopists also use the length of the colonoscope that has been introduced to provide information regarding tumour location. Colonoscopy is utilised in preoperative localisation of lesions, but most tumours are described in relation to major anatomic landmarks such as the ileocecal valve, hepatic flexure or splenic flexure.
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