Grossing of minimally invasive colorectal surgery

Author: Mikael Häggström

For a flat intestinal specimen from minimally invasive colorectal surgery:

• Measure dimensions
• Ink the surgical margins. If unoriented, ink at least the radial and deep margin in different colors.
• Describe any lesions
• Serially section the specimen.

Example of inking and serial sectioning of a minimally invasive colorectal surgery specimen. Sections too wide to fit into one cassette are split into halves.

• Select tissue for submission:

• For clearly demarcated lesions, generally submit the entire lesion, as well as an en face section in each direction (similarly to gross processing of suspected malignant skin excisions).
• For diffusely demarcated lesions, generally submit the entire specimen.

Gross report

Example:

((A. Labeled - ___. The specimen is received fresh and consists of)) a rhomboid-shaped fragment of pink-tan rectal wall measuring 4.5 x 3.7 cm and varying from 0.5 cm to 0.7 cm in thickness. The specimen has been oriented by the surgeon. The proximal margin is designated as 12:00 and the distal margin is designated as 6:00. The right margin is designated as 3:00 and the left margin is designated as 9:00. The surgical margins are inked as follows: 12:00 to 3:00 blue, 3:00 to 6:00 red, 6:00 to 9:00 green, 9:00 to 12:00 orange and deep black. The mucosal surface is tan and smooth and displays a central pale area measuring approximately 1.3 x 1.2 cm. The specimen is serially sectioned from 12:00 to 6:00 (proximal to distal) and entirely submitted for microscopic examination in eight cassettes, with the pale area in cassettes A3-A6. The 12:00 and 6:00 margins are submitted en face.

Evaluation

As per colon with tumor'.

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