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
Research background

Diagnosis of lympho-proliferative diseases is challenging. Although an excisional biopsy of a complete lymph node is the gold standard for diagnosis, endoscopic or percutaneous techniques are often used due to the surgical challenge the location of the lymph node imposes.

Research motivation

The current study describes a small case series of laparoscopic dissection of the hepatic node through a trans lesser omentum approach. This approach is rarely discussed in the English literature.

Research objectives

The study describes the clinical and surgical results of this novel technique.

Research methods

A single center, retrospective evaluation of patients undergoing laparoscopic dissection and excisional biopsy of the hepatic node.

Research results

During the time frame of the study, six patients were operated using this novel technique, with no conversions to laparotomy, no intra and post-operative complications and acceptable operating time. Most importantly, surgery yielded a definite diagnosis in all patients, and there was no need for further investigation.

Research conclusions

Laparoscopic dissection of the hepatic node seems to be feasible and safe, and surgeons may use this simple approach to a fairly complicated anatomical area in highly selected patients who do not have access to superficial lymph nodes.

Research perspectives

This study suggests that approach to the hepatic node and the celiac axis is easily and safely performed through a trans lesser omentum approach. This may facilitate future discussion on how to achieve the diagnosis of lympho-proliferative disease in patients who do not have enlarged and pathological superficial lymph nodes.