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

Needle aspiration and core biopsies are commonly used to assess retroperitoneal lymph nodes. However, the tissue obtained by this method is insufficient to define and type the tumour. This article demonstrates the feasibility and safety of the laparoscopic approach in obtaining an adequate volume of lymph node tissue for typing.

Laparoscopic retroperitoneal lymph node biopsy was performed on 12 patients over a period of five years. A pneumoperitoneum was induced with a Veress needle, and an initial 10-mm trocar was inserted in the sub-umbilical region in order to carry a 30-degree telescope. Two or more 5-mm ports were inserted into the targeted areas under laparoscopic guidance to achieve optimal triangulation in order to access the nodal tissue.

The procedure was successful in 11 out of the 12 patients. An average volume of 1.7 cm3 of tissue was harvested for each patient. In one patient with preoperatively undiagnosed portal hypertension, laparoscopy was converted to an open procedure due to bleeding. In all patients, the histology was adequate and contributed to the diagnosis, allowing rapid institution of treatment. The diagnosis was reactive lymphadenopathy in three patients and sarcoidosis in one patient. Seven others suffered from various conditions, including lymphoma, leukaemia, secondary from unknown origin and Castleman's disease.

Laparoscopy allows access to perihepatic and perisplenic areas, and is a procedure of choice when needle biopsy is not possible or fails to provide an adequate sample.