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Effectiveness and safety of minilaparoscopy-guided spleen biopsy: a retrospective series of 57 cases

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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.

Conclusion

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.

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Abbreviations

APC:

Argon plasma coagulation

B-NHL:

B-cell non-Hodgkin’s lymphoma

EBV:

Epstein-Barr virus/infectious mononucleosis

INR:

International normalized ratio

PCR:

Polymerase chain reaction

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Disclosures

Dr. Tobias Werner, Dr. Johannes Koch, Dr. Christian Frenzel, Prof. Dr. Ansgar W. Lohse, and PD Dr. Ulrike W. Denzer have no conflicts of interest or financial ties to disclose.

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Correspondence to Tobias Werner.

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Werner, T., Koch, J., Frenzel, C. et al. Effectiveness and safety of minilaparoscopy-guided spleen biopsy: a retrospective series of 57 cases. Surg Endosc 26, 2416–2422 (2012). https://doi.org/10.1007/s00464-012-2190-y

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  • DOI: https://doi.org/10.1007/s00464-012-2190-y

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