Management of diagnostic dilemmas of the pancreas by ultrasonographically guided laparoscopic biopsy

Introduction. Pancreatic lesions may be difficult to diagnose because of sm all size or inaccessibility. Such lesions are being seen with increasing fr equency because of advances in pancreatic imaging techniques. In the past 1 8 months we have evaluated 14-patients whose pancreatic lesions could not b e diagnosed by traditional means, including percutaneous biopsy. Methods. With the patient under general anesthesia, the anterior surface of the pancreas was exposed by a three-trocar laparoscopic technique. The les ion was located by laparoscopic ultrasonography. A core biopsy needle was i nserted into the lesion under simultaneous visual and ultrasonographic guid ance using picture-in-picture techniques. Results. The main diagnostic dilemma encountered was the differentiation of pancreatic cancer from pancreatitis. Other conditions were lymphoma and re nal cell carcinoma. Excellent tissue samples were obtained allowing diagnos is and planning of treatment in all cases. Operative time ranged from 1 to 4 hours, and length of stay ranged from 1 to 3 days. Blood transfusions wer e not required, and there were no complications. Alcohol nerve block was pe rformed laparoscopically in one patient in this group after the diagnosis w as made by frozen section. Conclusions. Direct ultrasonographically guided laparoscopic biopsy provide s rapid, safe diagnosis of pancreatic lesions.