If a tattoo is placed, the surgeon will look for it in the operating room to help identify the region of the colon that should be removed. Unfortunately, the tattoo may not always be visible to the surgeon because the ink may not have properly penetrated the colon wall to be seen from the outside. If the surgeon does not identify a tattoo in the region reported by the endoscopist, the surgeon may turn to some adjuncts to help definitively localize the tattoo. Intraoperative colonoscopy can be performed to give direct visualization of the lesion. Fluoroscopy can be used to help identify the location of a radiolucent clip if one was placed by the endoscopist.
Once the surgeon has confirmed the location of the lesion, he or she can remove that portion of the colon and open the specimen in the operating room to confirm its presence. The surgeon can also ask a pathologist to confirm in real time via frozen section the presence of the lesion in the specimen if there is any doubt with gross inspection alone.