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.
Similar content being viewed by others
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
References
Meister H, Trux F (1973) Experiences with the long Menghini needle in directed puncture of the liver and spleen. Dtsch Gesundheitsw 28:6–8
Bagley CM Jr, Thomas LB, Johnson RE et al (1973) Diagnosis of liver involvement by lymphoma: results in 96 consecutive peritoneoscopies. Cancer 31:840–847
Drobny H, Hanke P, Krug K (1975) Technic of Menghini’s liver and spleen biopsy from the aspect of laparoscopy. Dtsch Z Verdau Stoffwechselkr 35(2):75–79
Spinelli P, Beretta G, Bajetta E et al (1975) Laparoscopy and laparotomy combined with bone marrow biopsy in staging Hodgkin’s disease. Br Med J 4:554–556
Dagnini G, Galdironi MW, Marin G, Patella M (1984) Laparoscopic splenic biopsy. Endoscopy 16:55–58
Solbiati L, Bossi MC, Bellotti E, Ravetto C, Montali G (1983) Focal lesions in the spleen: sonographic patterns and guided biopsy. AJR Am J Roentgenol 140:59–65
Schwerk WB, Maroske D, Roth S, Arnold R (1986) Ultrasound-guided fine-needle puncture in the diagnosis and therapy of liver and spleen abscesses. Dtsch Med Wochenschr 111:847–853
Suzuki T, Shibuya H, Yoshimatsu S, Suzuki AS (1987) Ultrasonically guided staging splenic tissue core biopsy in patients with non-Hodgkin’s lymphoma. Cancer 60:879–882
Cavanna L, Civardi G, Foranri F, Di Stasi M, Sbolli G, Busarini E, Vallisa D, Rossi S, Tansini P, Buscarini L (1992) Ultrasonically guided percutaneous splenic tissue core biopsy in patients with malignant lymphomas. Cancer 69:2932–2936
Civardi G, Vallisa D, Bertè R, Giorgio A, Filice C, Caremani M, Caturelli E, Pompili M, De Sio I, Buscarini E, Cavanna L (2001) Ultrasound-guided fine needle biopsy of the spleen: high clinical efficacy and low risk in a multicenter Italian study. Am J Hematol 67(2):93–99
Lucey BC, Boland GW, Maher MM, Hahn PF, Gervais DA, Mueller PR (2002) Percutaneous nonvascular splenic intervention: A 10-year review. AJR Am J Roentgenol 179(6):1591–1596
Kang M, Kalra N, Gulati M, Lal A, Kochhar R, Rajwanshi A (2007) Image guided percutaneous splenic interventions. Eur J Radiol 64:140–146
Cavanna L, Lazzaro A, Vallisa D, Civardi G, Artioli F (2007) Role of image-guided fine-needle aspiration biopsy in the management of patients with splenic metastasis. World J Surg Oncol 5:13
Denzer U, Helmreich-Becker I, Galle PR, Lohse AW (2003) Liver assessment and biopsy in patients with marked coagulopathy: value of mini-laparoscopy and control of bleeding. Am J Gastroenterol 98:893–900
Denzer U, Helmreich-Becker I, Galle PR, Lohse AW (2002) Minilaparoscopy-guided spleen biopsy in systemic disease with splenomegaly of unknown origin. Endoscopy 34:495–498
Petersdorf RG, Beeson PB (1961) Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 40:1–30
Denzer U, Lohse AW (2008) Mini-laparscopy. Dtsch Med Wochenschr 133:1585–1588
Riemann JF (2003) Diagnostic laparoscopy. Endoscopy 35:43–47
Weickert U, Buttmann A, Jakobs R (2005) Diagnosis of liver cirrhosis- a comparison of modified ultrasound and laparoscopy in 100 consecutive patients. J Clin Gastroenterol 39:529–532
Denzer U, Arnoldy A, Kanzler S (2007) Prospective randomized comparison of minilaparoscopy and percutaneous liver biopsy. J Clin Gastroenterol 41:103–110
Denzer U, Hoffmann S, Helmreich-Becker I (2004) Minilaparoscopy in the diagnosis of peritoneal tumor spread-prospective controlled comparison with computed tomography. Surg Endosc 18:1067–1070
Livraghi T, Damascelli B, Lombardi C, Spagnoli I (1983) Risk in fine-needle abdominal biopsy. J Clin Ultrasound 11:77–81
Tatli S, Gerbaudo VH, Mamede M, Tuncali K, Shyn PB, Silverman SG (2010) Abdominal masses sampled at PET/CT-guided percutaneous biopsy: initial experience with registration of prior PET/CT images. Radiology 256:305–311
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2190-y