Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2020; 12(1): 77-82
Published online Jan 15, 2020. doi: 10.4251/wjgo.v12.i1.77
Laparoscopic dissection of the hepatic node: The trans lesser omentum approach
Offir Ben-Ishay
Offir Ben-Ishay, Department of General Surgery, Rambam Health Care Campus, Haifa 35254, Israel
Author contributions: Ben-Ishay O designed, drafted, and critically reviewed the manuscript.
Institutional review board statement: The study was approved by the institutional review board of the Rambam Health Care Campus, Haifa, Israel.
Informed consent statement: Informed consent was exempt by the institutional review board due to the retrospective nature of the study and no impact on the clinical outcome of the study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Conflict-of-interest statement: The author has no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Offir Ben-Ishay, MD, Director, Surgical Oncology, Department of General Surgery, Division of Surgery, Rambam Health Care Campus, 8 Ha'Aliyah St., Haifa 35254, Israel.
Received: July 2, 2019
Peer-review started: July 3, 2019
First decision: July 31, 2019
Revised: August 24, 2019
Accepted: September 26, 2019
Article in press: September 26, 2019
Published online: January 15, 2020

Diagnosis of lympho-proliferative diseases is sometimes challenging. Excisional lymph node biopsy is the standard of care. Five percent of the patients will present with abdominal or retroperitoneal lymphadenopathy alone. Advancements in endoscopic techniques allow for access to fine needle biopsy in complicated areas, but this often does not meet the standard guidelines for diagnosis.


To investigate the results of laparoscopic excisional biopsy of the hepatic node (LEBHN) through a trans lesser omentum approach.


Data of all patients undergoing LEBHN were collected retrospectively from patients’ electronic charts over a period of 1 year. Data collected included age, gender, suspected disease, number of previous biopsies and biopsy method, surgical approach, intraoperative complications, operative time, post-operative complications, mortality, and final diagnosis.


Six patients were operated in this technique during the time frame of the study, 66.6% (n = 4) were females, and median age was 55 years (range: 25-72 years). We present no conversions from laparoscopy to laparotomy, and mean operating time was 51.2 min. Mean length of hospital stay was 1 d, and morbidity and mortality were nil. Most importantly, this technique offered definite diagnosis and appropriate treatment in all patients. Final diagnosis included two patients with lymphoma (Hodgkin and Follicular), two patients with sarcoidosis, and two patients with reactive lymph nodes with no evidence of malignancy.


In conclusion, this technique seems to be feasible and safe and may offer a simple approach for a definite diagnosis for what seems to be a complicated anatomical area.

Keywords: Lymph node, Diagnosis, Lymphoma, Laparoscopy, Biopsy, Retroperitoneum

Core tip: Diagnosis of lympho-proliferative diseases is sometimes challenging, and laparoscopy is an essential tool. Laparoscopic excisional biopsy of the hepatic node seems to be feasible and safe and may offer a simple approach for a definite diagnosis for what seems to be a complicated anatomical area.