World Journal of Laparoscopic Surgery

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VOLUME 16 , ISSUE 3 ( September-December, 2023 ) > List of Articles


Can Analysis of Washings Sucked Out during Laparoscopic Surgeries Improve Lymph Node Yield?

Subbiah Shanmugam, Aravind Shivakumar

Keywords : Laparoscopic, Nodal yield, Surgical washings

Citation Information : Shanmugam S, Shivakumar A. Can Analysis of Washings Sucked Out during Laparoscopic Surgeries Improve Lymph Node Yield?. World J Lap Surg 2023; 16 (3):173-174.

DOI: 10.5005/jp-journals-10033-1592

License: CC BY-NC 4.0

Published Online: 12-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: Lymph node metastasis is one of the most important factors determining survival in most malignancies. Better lymph node yield improves survival in many cancers. We tried to analyze the laparoscopic surgical washings for the presence of lymphatic tissue/deposits to improve information on nodal involvement. Saline is instilled and washings are sucked out during laparoscopic surgeries. How much information on lymph node involvement is lost because of these washings not being analyzed is an important question we wanted to answer. Materials and methods: We prospectively evaluated the surgical washings of patients undergoing laparoscopic surgery at our institution from May 2022 to December 2022. All patients with biopsy-proven malignancies who underwent laparoscopic surgery including regional nodal assessment were included in the study. These included patients with carcinoma cervix, carcinoma stomach, carcinoma esophagus, and carcinoma rectum. The only exclusion criterion was not having proof of malignancy through biopsy. The pelvic nodes were separately removed in an endobag for patients with carcinoma cervix, minimizing spillage. The surgical wash fluid obtained from routine irrigation and suction of the surgical field with 0.9% NS (minimum of 1L) was collected. Unfractionated heparin of 1 mL was added to the fluid. After 24 hours, the solution would be centrifuged and analyzed by the pathologists. Suspicious tissues would be analyzed for the presence of lymphoid material and tumor deposits. A total of 50 patients were analyzed, which included 32 patients with carcinoma cervix, eight patients with carcinoma stomach, four patients with carcinoma esophagus, and six patients with carcinoma rectum. Results: Amongst the 50 patients studied, none of them had the presence of lymph nodes in the surgical wash fluid. Conclusion: A simple analysis of the surgical washings of patients undergoing laparoscopic cancer that included nodal dissection failed to provide better information on nodal involvement. With the background of limitations of our study, better handling of fluid irrigated and sucked out may lead to better information. But as of now, analysis of irrigation fluid during laparoscopic surgery is not useful.

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