38570 Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple

Name of the Procedure:

Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple
Common names: Laparoscopic lymph node biopsy, Retroperitoneal lymph node sampling.

Summary

Laparoscopy with retroperitoneal lymph node sampling is a minimally invasive surgical procedure in which a surgeon uses a laparoscope (a thin, lighted tube) to access and sample lymph nodes in the retroperitoneal space (the area behind the peritoneum, the lining of the abdominal space) for biopsy purposes.

Purpose

This procedure is performed to diagnose or stage certain cancers, such as testicular cancer, lymphoma, or other malignancies that may spread to or originate in the retroperitoneal lymph nodes. The goal is to obtain tissue samples from these lymph nodes to determine the presence, type, and extent of cancer.

Indications

• Suspicious lymphadenopathy (enlarged lymph nodes) detected via imaging studies.
• Symptoms suggesting retroperitoneal involvement of cancers.
• Follow-up of previously diagnosed malignancies to check for recurrence or metastasis.
• Unexplained abdominal or back pain associated with lymph node enlargement.

Preparation

• Patients are typically advised to fast for 6-8 hours before the procedure.
• Medications may be adjusted or stopped based on the physician's advice (e.g., anticoagulants).
• Preoperative blood tests, imaging studies (CT or MRI scans), and a complete medical evaluation are usually conducted.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incisions: Small incisions (usually 3-4) are made in the abdominal wall.
3. Laparoscope Insertion: A laparoscope is inserted through one of the incisions to allow visualization of the abdominal contents.
4. Retroperitoneal Access: Additional instruments are used to gently move aside tissues and gain access to the retroperitoneal space.
5. Lymph Node Sampling: Lymph nodes are identified, and biopsy samples are taken using specialized tools.
6. Closing Incisions: The instruments are withdrawn, and the incisions are closed with sutures or surgical glue.

Duration

The procedure typically takes between 1-3 hours, depending on the number and accessibility of lymph nodes being sampled.

Setting

This procedure is usually performed in a hospital's operating room or a specialized surgical center.

Personnel

• Surgeon specialized in laparoscopic or oncologic surgery.
• Anesthesiologist.
• Operating room nurses.
• Surgical technologists.

Risks and Complications

• Infection at the incision sites.
• Bleeding or hematoma formation.
• Injury to surrounding organs (e.g., bowel, bladder, blood vessels).
• Complications from anesthesia.
• Postoperative pain or discomfort.
• Rarely, lymphocele (a collection of lymphatic fluid).

Benefits

• Minimally invasive with smaller incisions, less pain, and quicker recovery compared to open surgery.
• Provides precise diagnostic information to guide further treatment.
• Shorter hospital stay and faster return to normal activities.

Recovery

• Patients may experience mild pain or discomfort controlled with medications.
• Most patients can go home the same day or the day after the procedure.
• Instructions typically include wound care, activity restrictions (e.g., no heavy lifting), and follow-up appointments.
• Full recovery usually occurs within 1-2 weeks, but complete healing of internal tissues may take longer.

Alternatives

• Open surgical biopsy: More invasive with larger incisions and longer recovery.
• Needle biopsy: Less invasive but may not provide sufficient tissue for diagnosis.
• Imaging-guided biopsy: Minimally invasive but may be limited by accessibility and the size/location of lymph nodes.

Patient Experience

• During the procedure, under general anesthesia, the patient will be asleep and unaware of the process.
• Post-procedure, patients may feel mild to moderate pain at the incision sites, manageable with prescribed pain medications.
• Mild bloating or tenderness in the abdomen is common for several days after the procedure.