Preoperative Tattooing for Precise and Expedient Localization of Landmark in Laparoscopic Liver Resection Takeshi Aoki, MD, PhD, Masahiko Murakami, MD,

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Preoperative Tattooing for Precise and Expedient Localization of Landmark in Laparoscopic Liver Resection Takeshi Aoki, MD, PhD, Masahiko Murakami, MD, PhD, Tomotake Koizumi, MD, PhD, Tomokazu Kusano, MD, PhD, Akira Fujimori, MD, PhD, Yuta Enami, MD, PhD, Kazuhiro Matsuda, MD, PhD, Satoru Goto, MD, PhD, Makoto Watanabe, MD, PhD, Koji Otsuka, MD, PhD Journal of the American College of Surgeons Volume 221, Issue 5, Pages e97-e101 (November 2015) DOI: 10.1016/j.jamcollsurg.2015.07.444 Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 1 (A) Preoperative ultrasound-guided tattooing of hepatic landmarks. (B) An 18-gauge fine needle was inserted at the margin of the lesion. Journal of the American College of Surgeons 2015 221, e97-e101DOI: (10.1016/j.jamcollsurg.2015.07.444) Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 2 (A) Intraoperative view of a 72-year-old woman with hepatocellular carcinoma in segment 4. Laparoscopic intraoperative ultrasound was performed to obtain information on the free surgical margin and the anatomic relationship between the vessels and the tumor. (B) During transection, the local landmark with a tattoo (white arrow) was easily identified. (C) The vessels with the tattoo (white arrow) were dissected and clipped. (D) Intraoperative view of an 81-year-old woman with metastatic liver cancer in segment 6. The local landmark with the tattoo (white arrow) was also easily identified. (E) Intraoperative view of a 64-year-old man with metastatic liver cancer in segment 4. The local landmark with the tattoo (white arrow) was easily visible and the vessels with the tattoo were dissected and clipped. Journal of the American College of Surgeons 2015 221, e97-e101DOI: (10.1016/j.jamcollsurg.2015.07.444) Copyright © 2015 American College of Surgeons Terms and Conditions