title: Effectiveness and safety of minilaparoscopy-guided spleen biopsy: a retrospective series of 57 cases.
abstract: BACKGROUND
  Minilaparoscopy is an accepted method for liver biopsy. We report our experience with minilaparoscopy for splenic biopsy.
  
  
  METHODS
  We reviewed the records of all minilaparoscopy procedures performed from 1996 to 2004 at the University of Mainz Medical Center and from 2005 to mid-2011 at the University of Hamburg Medical Center to identify patients who underwent a minilaparoscopy-guided splenic biopsy. All procedures were performed using the previously described method (2.75-mm trocar, 2.3-mm Veress needle, 1.9-mm laparoscope) with the patient under conscious sedation (midazolam/meperidine/propofol). Splenic biopsies were performed using a second trocar with an 18-G Tru-Cut needle. Argon plasma coagulation (APC) and/or fibrin glue (FG) were used to control postbiopsy bleeding.
  
  
  RESULTS
  Fifty-seven patients underwent minilaparoscopy-guided biopsy of the spleen (27 females, 30 males; median age = 41 years, range = 16-76). A specimen suitable for histopathologic evaluation was obtained in all patients. Grouped by preprocedure indication, a definitive diagnosis was obtained in 70% (7/10) of patients who had splenic mass lesions in prior imaging (3 B-NHL, 2 hemangioma, 1 tuberculosis, 1 sarcoidosis; p < 0.01) compared to 29% (10/34) in the group with unexplained fever or suspected lymphoma (3 tuberculosis, 2 B-NHL, 1 hepatosplenic T-cell lymphoma, 1 sarcoidosis, 1 Still's disease, 1 EBV, 1 Q-fever) and 0/13 with unexplained splenomegaly. Focal lesions noted at laparoscopy yielded to a histologic diagnosis in 38% (11/29) of 42 patients compared to 21% (6/28) without laparoscopic abnormality (p = 0.25). Bleeding from the biopsy site was noted in 96.5% (55/57) and was classified as brisk in 9. Control of hemorrhage was achieved in all patients (APC: 47, FG: 1, APC/FG: 7). There was no postprocedure bleeding or other complications.
  
  
  CONCLUSIONS
  Splenic biopsy guided by minilaparoscopy can be performed safely. Postprocedure bleeding is readily controlled with APC with or without fibrin glue. The highest diagnostic yield is in patients with focal splenic lesions.
authors.affiliation: I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. t.werner@uke.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Werner
authors.forename: Johannes
authors.initials: J
authors.lastname: Koch
authors.forename: Christian
authors.initials: C
authors.lastname: Frenzel
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
authors.forename: Ulrike W
authors.initials: UW
authors.lastname: Denzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology*; D055815:Young Adult