Colonic tattooing in laparoscopic surgery - making the mark?

Laparoscopic surgery for colorectal cancer is now widespread. Small lesions in the colon can be difficult to palpate and with lack of tactile sensation, it is essential to accurately localize them preoperatively. This is a review article on current methods of tattooing including the use of different agents and associated complications. To review current techniques in preoperative tumour localization and methods used for colonic tattooing including agents used, dosage and potential complications. A literature search (Medline and Pubmed) was performed with manual cross referencing of all articles related to colonic tattooing. Methods for localizing colonic tumours for laparoscopic resection include preoperative barium enema examination, CT colonography and intraoperative colonoscopy. The most effective method is, however, by tattooing with India ink performed endoscopically before surgery. India ink is a reliable method of marking tumour location within the colon as prelude to laparoscopic resection. Surgeons must, however, be aware of potential complications associated with this technique.