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Transcutaneous pleural biopsy with a retrograde forceps: a novel approach

Abstract

Purpose

Pleural biopsies are commonly performed to investigate the cause of exudative pleural effusion. Biopsy needles (e.g. Abrams needle, Cope needle) are traditionally used to perform the biopsy. However, certain complications such as pneumothorax and haemothorax have been described. We present a technique utilizing a novel retrograde forceps, which could improve the simplicity and lower the complication rate of performing closed pleural biopsies.

Description

A retrograde forceps (Retroforceps, Karl Storz, Tuttlingen, Germany) was used to perform 20 transcutaneous pleural biopsies in a cadaver thorax under thoracoscopical control. Video documentation of the procedure from outside and inside the thorax was performed. The surgeon performing the biopsy was blinded to the thoracoscopical view. After the removal of the forceps, it was checked whether biopsy material was retrieved. The video material was retrospectively used to confirm whether the biopsy was taken from the pleura parietalis.

Evaluation

Biopsy material was retrieved in 19 out of 20 biopsy attempts. Video material confirmed that the biopsy was taken from the pleura parietalis in all cases.

Conclusions

Using a retrograde biopsy forceps is a simple and practicable procedure suitable for clinical application. This technique could potentially reduce the incidence of pneumothorax.

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Acknowledgments

We thank Reto Kaesermann, Mike Mueller, and Bernd Friker for excellent technical support.

Disclosures

Martin Wiewiorski, Andreas Hiebinger, Sebastian Hoechel, Magdalena Müller-Gerbl, Alexej Barg, Victor Valderrabano, and Thomass Hügle have declared that they have no conflicts of interest.

Author information

Correspondence to Thomas Hügle.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1. Biopsy technique. All steps of this procedure can be performed without thoracoscopical assistance. However, to demonstrate the key steps and technical aspects of the biopsy, this video provides a thoracoscopical view of the procedure. The key steps are as follows: skin incision, penetrating the joint capsule with the forceps, opening the forceps, pulling the open jaw against the synovial membrane, closing the jaw, and retrieving the biopsy sample from the jaw. Supplementary material 1 (MP4 3588 kb)

Video 1. Biopsy technique. All steps of this procedure can be performed without thoracoscopical assistance. However, to demonstrate the key steps and technical aspects of the biopsy, this video provides a thoracoscopical view of the procedure. The key steps are as follows: skin incision, penetrating the joint capsule with the forceps, opening the forceps, pulling the open jaw against the synovial membrane, closing the jaw, and retrieving the biopsy sample from the jaw. Supplementary material 1 (MP4 3588 kb)

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Cite this article

Wiewiorski, M., Hiebinger, A., Hoechel, S. et al. Transcutaneous pleural biopsy with a retrograde forceps: a novel approach. Surg Endosc 30, 396–400 (2016) doi:10.1007/s00464-015-4204-z

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Keywords

  • Pleura
  • Biopsy
  • Forceps