Laparoscopy-assisted trans-gastric endoscopic biopsy of retroperitoneal lymph node： a report of 1 case in human being

Abstract

Objective To evaluate the feasibility of getting retroperitoneal lymph node biopsy via technique of natural orifice transluminal endoscopic surgery （NOTES） in human being with current available devices. Methods We performed trans-gastric endoscopic biopsy of retroperitoneal lymph node with the aid of laparoseopy in a 50-year-old man, who presented with abdominal pain and enlarged retroperitoneal lymph nodes and signed a written informed consent before the procedure. After routine anesthesia and abdominal skin sterilization, a pneumoperitoneum was induced with a Veress needle placed in the umbilical area, followed by the introduction of a 5-mm trocar. Gastral cavity was sterilized with antibiotics and povidone iodine. Under laparoscopic optical control, we made a styliform incision in the anterior wall of gastric corpus with a needle knife, and enlarged the incision by a dilatation balloon and then entered the peritoneal cavity with a sterile endoscope. We got two biopsies from the enlarged lymph node with a heat forceps assisted by laparoscopy. The specimen was taken out by retrieval basket through the stomach. The gastric incision was closed with metal clips. Results The biopsy by means of NOTES was successfully performed without intra- or postoperative complications. The diagnosis was confirmed as lymphoma pathologically. The patient received chemotherapy and was discharged on the sixth postoperative day. There was no short or long-term complication. Conclusion Transgastric access for laparoscopy-assisted biopsy of retroperitoneal lymph node is feasible and safe in human being. Key words: Endoscopic surgical procedures; Lymph nodes; Biopsy; Natural orifice transluminal endoscopic surgery