Introduction & Objective :
Though uncommon, the medicolegal ramifications of wrong sided surgery are catastrophic. While skin marking is a proven technique to confirm laterality in open surgical procedures, it is less useful in endoscopic procedures as markings are covered by drapes and not visible on fluoroscopic imaging. Recently a novel radiopaque tape marker (′′X Site′′, Target Tape Inc; Surrey, British Columbia) was introduced to assist in confirming laterality for patients undergoing endourologic surgery. We sought to assess this in clinical practice.
Institutional review board approval was obtained to study the utility of the X-site marker in clinical practice. 40 patients undergoing upper tract endourologic surgery had an X Site sticker applied preoperatively to their torso 4 fingerbreadths lateral to and just below the level of the umbilicus overlying the side of planned surgery. Visualization of the sticker was then confirmed on intraoperative fluoroscopic imaging once under anesthesia. Patients and surgeons were surveyed 1-2 days following the procedure regarding their satisfaction with the sticker as well as intraoperative or postoperative issues with its use.
The X Site sticker was immediately apparent on the initial, guided fluoroscopic image in 39/40 cases (97.5%). In one case, additional fluoroscopy was required in order to identify the marker. Patient body mass index ranged from 22.7-43.8 (mean 29.9). There were no cases of the sticker being dislodged or obscuring views of the kidney or ureter. Among respondents to the post procedure survey, there were no reports of local reaction from sticker application. The majority of patients (11/14, 79%) reported that the sticker improved their concerns about wrong sided surgery.
Conclusions : The X Site marker is reliable and readily identifiable in the vast majority of cases when applied in the described fashion. Application of the X Site sticker has the potential to improve patient safety and prevent wrong sided endourologic surgery by allowing real time confirmation of laterality on fluoroscopic imaging.
Colby Dixon– Urology Resident, University of Minnesota, Minneapolis, Minnesota
Resha Tejpaul– Research Assistant , University of Minnesota , Minneapolis, Minnesota
Maria Ordonez– Assistant Professor, University of Minnesota, Minneapolis, Minnesota
Michael Borofsky– Assistant Professor, University of Minnesota, Minneapolis, Minnesota