Laparoscopic ultrasonography-assisted retroperitoneal lymph node sampling in patients evaluated for stomach cancer recurrence

Objective. The precise localization of target lymph nodes during laparoscopic biopsy can often be technically challenging. The purpose of this series was to report 2 patients who successfully underwent laparoscopic para-aortic lymph node sampling with the assistance of laparoscopic ultrasonography (LUS). Methods. We describe 2 patients previously treated for gastric cancer who later had suspicious retroperitoneal lymphadenopathy detected by computed tomography. They received LUS-assisted lymph node biopsies for histologic evaluation. Results. Laparoscopic ultrasonography precisely localized the target lymph nodes, which measured 1.4 and 1.5 cm, respectively, in both patients. A transperitoneal laparoscopic approach and target lymph node sampling were successfully performed. No procedure-related technical difficulties or immediate complications occurred. The 2 patients were histologically proven to have nodal tumor recurrence and tuberculous lymphadenopathy, respectively. Conclusions. Precise localization of a small lymph node located deep in the abdomen can be readily performed by intraoperative LUS.