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Introduction: Preoperative localisation of tumour is an essential requirement in Laparoscopic colorectal surgery. Tattooing guidelines should be simple to follow and consistent for all lesions irrespective of the location of the tumour.

Our recommendations were: To place at least two spots of tattoo distal to each lesion, and clearly document site of tattoo with respect to tumour in the endoscopy report.

Method: We conducted a prospective audit of endoscopic tattooing of colorectal tumours resected in our hospital from February 2010 to January 2011. It was felt that the current guidelines were too complicated, leading to higher rates of inaccurate tattooing. Thereafter new guidelines were developed and subsequent practice reaudited.

Results:
2010: 37 patients in total were identified. 14 were not tattooed. 3 patients had a tattoo which was inaccurate. 13 had accurate and well documented tattoos. 7 patients had tattoos of unknown accuracy.
2011: 24 patients in total were identified. 6 patients were not tattooed. 4 patients had no tattoos visible at operation. 1 patient had a tattoo which was inaccurate. 11 patients had accurate and well documented tattoos. 2 patients had tattoos of unknown accuracy.

Of those patients which were tattooed and seen at surgery, 78.6% were accurate and clearly documented in 2011 compared to 56.5% in 2010 (p=0.2124)

Of those patients which were tattooed and seen at surgery, 14.2% had unknown accuracy (not clearly documented) in 2011, compared to 30.4% in 2010 (p=0.3032)

Of those patients which were tattooed and seen at surgery 7.14% were deemed inaccurate (tattoo in wrong place) in 2011, compared to 13.04% in 2010 (p=0.6043).

Conclusion: The simpler method of tattooing all tumours distally has improved the accuracy of tattooing.