title: A novel technique for diaphragm biopsies in human patients.
abstract: BACKGROUND
  The diaphragm is difficult to biopsy because of its anatomic location. We describe a new laparoscopic diaphragm biopsy technique.
  
  
  METHODS
  Fifty one patients with amyotrophic lateral sclerosis gave their consent to diaphragm biopsy in the context of an implanted phrenic nerve stimulation protocol (NCT01583088). The biopsy was taken from the costal diaphragm, after opening the parietal peritoneum with scissors, and by grasping the diaphragmatic muscle over the rib with toothed laparoscopy forceps.
  
  
  RESULTS
  The first four electrocoagulation biopsies were unsuitable for morphologic examination. The following 47 biopsies were therefore performed without electrocoagulation. The mean size of the biopsy fragments obtained after preparation was 3 ± 1 × 2 ± 1 × 1 ± 1 mm (maximum: 4 × 3 × 2 mm). A diaphragmatic injury occurred during the section in three cases requiring immediate suture without causing pneumothorax. A small pleural effusion was observed on the postoperative chest x-ray in one patient with a spontaneously favorable outcome. Numerous stains were able to be performed on the fragments obtained.
  
  
  CONCLUSIONS
  Diaphragm biopsy can be safely performed by laparoscopy and yields tissue suitable for our future histologic evaluation.
authors: AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service Chirurgie Viscerale, Paris, France.
authors: Séverine
authors: S
authors: Noullet
authors: AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Institute of Myology-INSERM.U523, Paris, France; Banque de Tissus MYOBANK-AFM de l'Institut de Myologie, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
authors: Norma
authors: N
authors: Romero
authors: AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service Chirurgie Viscerale, Paris, France.
authors: Fabrice
authors: F
authors: Menegaux
authors: Banque de Tissus MYOBANK-AFM de l'Institut de Myologie, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
authors: Maud
authors: M
authors: Chapart
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France.
authors: Alexandre
authors: A
authors: Demoule
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France.
authors: Capucine
authors: C
authors: Morelot-Panzini
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France.
authors: Thomas
authors: T
authors: Similowski
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France. Electronic address: jesus.gonzalez@psl.aphp.fr.
authors: Jésus
authors: J
authors: Gonzalez-Bermejo
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000473:pathology* / Q000601:surgery; D001706:Biopsy / Q000379:methods; D003964:Diaphragm / Q000473:pathology*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged
keywords: Amyotrophic lateral sclerosis; Biopsy; Diaphragm; Laparoscopy; Neuromuscular disease; Surgery