title: Advantage of urological experience with both transperitoneal and retroperitoneal laparoscopy in lymph node biopsy for malignant lymphoma diagnosis.
abstract: Laparoscopic urologists are familiar with both transperitoneal and retroperitoneal approaches. That experience is an advantage when devising a strategy for intra-abdominal lymph node biopsy. We report the feasibility and effectiveness of laparoscopic biopsy using a urological laparoscopic technique for the treatment of patients with clinically suspected intra-abdominal lymphoma.
  
  
  
  From October 2010 to April 2015, a total of 22 patients underwent laparoscopic biopsy for suspected intra-abdominal lymphoma. We adopted a retroperitoneal approach for paraaortic or paracaval masses, whereas we used a transperitoneal approach for mesenteric, iliac, or obturator masses. Whenever possible, an entire node was removed; otherwise, the biopsy consisted of wedge resection sized at least 1 cm3.
  
  
  
  Biopsy specimens were obtained from the following lymph node sites: 10 paraaortic, 5 paracaval, 3 mesenteric, 2 obturator, 1 common iliac, and 1 perinephric fat. Laparoscopic lymph node biopsy was completed in all patients, and there were no conversions to open surgery. The median operating time was 97 minutes (range, 62-167 minutes). The estimated blood loss was <50 mL in all cases. Postoperatively, one patient (4.5%) had symptomatic chylous lymphocele that required surgical intervention. Precise diagnosis was established for all patients: malignant lymphoma in 20 patients and metastatic urothelial carcinoma and squamous cell carcinoma of unknown origin in 1 patient each. All lymphomas could be fully subclassified.
  
  
  
  Appropriate use of the transperitoneal or retroperitoneal approach is safe and effective for laparoscopic lymph node biopsy in patients with suspected intra-abdominal lymphoma.
authors.affiliation: Department of Urology, Tenri Hospital, Tenri, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawanishi
authors.affiliation: Department of Urology, Tenri Hospital, Tenri, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Urology, Tenri Hospital, Tenri, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kamido
authors.affiliation: Department of Urology, Tenri Hospital, Tenri, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kohno
authors.affiliation: Department of Urology, Tenri Hospital, Tenri, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Uemura
authors.affiliation: Department of Urology, Tenri Hospital, Tenri, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of Urology, Tenri Hospital, Tenri, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Uetsuki
authors.affiliation: Department of Hematology, Tenri Hospital, Tenri, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ohno
authors.affiliation: Department of Urology, Tenri Hospital, Tenri, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Okumura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D049268:Positron-Emission Tomography; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D013520:Urologic Surgical Procedures / Q000592:standards
keywords: Biopsy; Laparoscopy; Lymph nodes; Lymphoma