title: A novel approach: transumbilical endoscopic exploration and biopsy for patients with unknown ascites.
abstract: BACKGROUND
  The main surgical methods used for the diagnosis of unknown ascites are laparotomy, laparoscopic exploration, and natural orifice translumenal endoscopic surgery (NOTES). This article introduces a novel method: transumbilical endoscopic exploration and biopsy.
  
  
  METHODS
  From September 2009 to January 2012, 11 patients with unknown ascites were scheduled for transumbilical endoscopic exploration and biopsy at the First Affiliated Hospital of Harbin Medical University, Harbin, China. After the patient underwent general anesthesia and artificial pneumoperitoneum, a 1.0-cm trocar was placed at the umbilical region. After initial observation of the whole peritoneal cavity with a laparoscope, a sterile endoscope (gastroscope) was put through the trocar. The surgeon regulated the depth of insertion of the endoscope and the direction of the trocar, while the endoscopic physician was in charge of turning the camera lens of the endoscope, controlling the biopsy forceps, irrigation, and suction. After exploration, four to six pieces of tissues were obtained for biopsy.
  
  
  RESULTS
  These patients were diagnosed by endoscopic exploration and pathological examination: 3 cases were tuberculous peritonitis, 2 cases were malignant peritoneal mesotheliomas, 2 cases were peritoneal carcinomatosis, 1 case was a small intestinal tumor, 2 cases were advanced ovarian cancer, and 1 case was cirrhosis.
  
  
  CONCLUSIONS
  Transumbilical endoscopic exploration and biopsy is an easy, practical, and effective method for the diagnosis of unknown ascites.
authors: Department of Gastroenterology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors: Youlin
authors: Y
authors: Yang
authors: Weihui
authors: W
authors: Zhang
authors: Hongyu
authors: H
authors: Xu
authors: Hang
authors: H
authors: Lv
authors: Zhibin
authors: Z
authors: Ma
authors: Dongbo
authors: D
authors: Xue
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000175:diagnosis* / Q000209:etiology*; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D014472:Umbilicus