Background and Purpose: When percutaneous image-guided biopsies are not possible for retroperitoneal tumor of unknown origin (RTUO), surgical tissue diagnosis becomes necessary. Laparotomy and laparoscopic surgery are current standard treatments; however, the laparoendoscopic single-site (LESS) approach offers many potential benefits. We describe our technique for LESS biopsy of RTUO. Patients and Methods: Five patients underwent LESS biopsy for diagnosis of RTUO. A multichannel port was inserted into the peritoneal or retroperitoneal space through a 3-cm skin incision, which adequately exposed the retroperitoneal tumor. The specimen was grasped and isolated circumferentially from the surrounding tissue. Results: LESS surgery was performed successfully without any complications such as open conversion. Mean operative time was 183 min and estimated blood loss was negligible. The diagnoses were IgG4-related retroperitoneal fibrosis (n = 4) and lymphoma (n = 1). Sufficient specimens were safely obtained not only for pathological diagnosis but also for further examinations such as immunophenotyping or DNA analysis. Convalescence was satisfactory. All patients were treated appropriately according to the resulting diagnosis. Conclusions: LESS biopsy for RTUO is a safe and effective alternative to open surgical and standard laparoscopic biopsies. Further studies of clinical experiences are needed to confirm the benefits of this new technique.

Keywords:
Laparoendoscopic single-site surgery, Biopsy, IgG4-related retroperitoneal fibrosis, Lymphoma
1.
Pavlidis N, Briasoulis E, Hainsworth J, Greco FA: Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer 2003;39:1990–2005.
2.
Hesselmann V, Zähringer M, Krug B, Wesselmann C, Haferkamp K, Wickenhauser C, et al: Computed-tomography-guided percutaneous core needle biopsies of suspected malignant lymphomas: impact of biopsy, lesion, and patient parameters on diagnostic yield. Acta Radiol 2004;45:641–645.
3.
Balestreri L, Morassut S, Bernardi D, Tavio M, Talamini R, Gloghini A, et al: Efficacy of CT-guided percutaneous needle biopsy in the diagnosis of malignant lymphoma at first presentation. Clin Imaging 2005;29:123–127.
4.
Gupta S: New techniques in image-guided percutaneous biopsy. Cardiovasc Intervent Radiol 2004;27:91–104.
5.
Ojalehto M, Tikkakoski T, Rissanen T, Apaja-Sarkkinen M: Ultrasound-guided percutaneous thoracoabdominal biopsy. Acta Radiol 2002;43:152–158.
6.
Koep L, Zuidema GD: The clinical significance of retroperitoneal fibrosis. Surgery 1977;81:250–257.
7.
Diulus L, Chalikonda S, Pitt T, Rosenblatt S: Efficacy of laparoscopic mesenteric/retroperitoneal lymph node biopsy. Surg Endosc 2009;23:389–393.
8.
Asoglu O, Porter L, Donohue JH, Cha SS: Laparoscopy for the definitive diagnosis of intra-abdominal lymphoma. Mayo Clin Proc 2005;80:625–631.
9.
Liao YT, Wu MH, Wang MY, Lee PC, Yang CY, Lin MT, Lee PH: Gasless laparoscopy-assisted surgery for intraabdominal/retroperitoneal tumor of unknown origin: a bridge between total laparoscopic surgery and conventional open surgery. J Laparoendosc Adv Surg Tech A 2010;20:825–830.
10.
Bhandarkar DS, Shah RS, Katara AN, Shankar M, Chandiramani VA, Udwadia TE: Laparoscopic biopsy in patients with abdominal lymphadenopathy. J Minim Access Surg 2007;3:14–18.
11.
Kottra JJ, Dunnick NR: Retroperitoneal fibrosis. Radiol Clin North Am 1996;34:1259–1275.
12.
Tanabe T, Tsushima K, Yasuo M, Urushihata K, Hanaoka M, Koizumi T, et al: IgG4-associated multifocal systemic fibrosis complicating sclerosing sialadenitis, hypophysitis, and retroperitoneal fibrosis, but lacking pancreatic involvement. Intern Med 2006;45:1243–1247.
13.
Zen Y, Onodera M, Inoue D, Kitao A, Matsui O, Nohara T, et al: Retroperitoneal fibrosis: a clinicopathologic study with respect to immunoglobulin G4. Am J Surg Pathol 2009;33:1833–1839.
14.
Van Moerkercke W, Verhamme M, Meeus G Oyen R, Steenbergen WV: A case of IgG4-related sclerosing disease with retroperitoneal fibrosis, autoimmune pancreatitis and bilateral focal nephritis. Pancreas 2009;38:825–832.
15.
Zen Y, Sawazaki A, Miyayama S, Oyen R, Steenbergen WV: A case of retroperitoneal and mediastinal fibrosis exhibiting elevated levels of IgG4 in the absence of sclerosing pancreatitis (autoimmune pancreatitis). Hum Pathol 2006;37:239–243.
16.
Takashima T, Onoda N, Ishikawa T, Koyama T, Inaba M, Nishizawa Y, et al: Tumor-forming idiopathic retroperitoneal fibrosis: report of a case. Surg Today 2004;34:374–378.
17.
Ben-Yehuda D, Polliack A, Okon E, Sherman Y, Fields S, Lebenshart P, et al: Image-guided core-needle biopsy in malignant lymphoma: experience with 100 patients that suggests the technique is reliable. J Clin Oncol 1996;14:2431–2434.
18.
Hara I, Tanaka K, Yamada Y, Miyake H, Takenaka A, Fujisawa M: Usefulness of laparo- or retroperitoneoscopic biopsy for retroperitoneal lymph node swelling of unknown origin. Int J Urol 2007;14:466–469.
© 2012 S. Karger AG, Basel
2012
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