Promising Novel Technique for Tumor Localization in Laparoscopic Colorectal Surgery Using Indocyanine Green-Coated Endoscopic Clips

Minimally invasive surgery has become the standard for management of colorectal cancer. The accurate localization of a tumor before surgery is important, especially in the early stages of cancer, to clarify the extent of surgical resection.1,2 Several methods are currently being proposed and used to identify the location of tumors. These include preoperative endoscopic tattooing using India ink, indocyanine green (ICG), or autologous blood, preoperative endoscopic clipping with detection using an x-ray or palpation during surgery, double-contrast barium enema, CT colonography, and intraoperative colonoscopy.3–9 Recently, lesion site labeling using near-infrared fluorescent materials that penetrate the colonic wall has been proposed to overcome the shortcomings of the methods listed above.10,11 This method involves placing endoscopic clips coated or mounted with near-infrared fluorescent material, such as ICG, at the lesion site and determining the location of the tumor by detecting the fluorescent signal through the intestinal wall by using a near-infrared laparoscope.11 The purpose of this study is to assess the feasibility and efficacy of the ICG-coated endoscopic clips for tumor localization in laparoscopic colorectal surgery.