Laparoscopic retroperitoneal/mesenteric lymph node sampling: a safe and effective technique.

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Diagnostic Pathology

Background:

• Traditional needle aspiration and core biopsies often yield insufficient tissue for accurate retroperitoneal lymph node tumor typing.
• Assessing retroperitoneal lymph nodes is crucial for diagnosing various conditions.

Purpose of the Study:

• To demonstrate the feasibility and safety of using a laparoscopic approach for retroperitoneal lymph node biopsy.
• To obtain an adequate volume of lymph node tissue for definitive diagnosis and typing.

Main Methods:

• A laparoscopic retroperitoneal lymph node biopsy procedure was performed on 12 patients over five years.
• Utilized a Veress needle for pneumoperitoneum and multiple trocars under laparoscopic guidance for nodal tissue access.

Main Results:

• The procedure was successful in 11 of 12 patients, yielding an average of 1.7 cm³ of tissue per patient.
• Histology was adequate in all successful cases, aiding rapid diagnosis of conditions including lymphoma, sarcoidosis, and Castleman's disease.
• One conversion to open procedure occurred due to bleeding in a patient with undiagnosed portal hypertension.

Conclusions:

• Laparoscopic biopsy is a viable and safe option for obtaining adequate retroperitoneal lymph node tissue.
• This technique is particularly valuable when needle biopsies are insufficient or impossible.
• Laparoscopy provides access to perihepatic and perisplenic regions for lymph node assessment.