Background: Laparoscopic staging of abdominal diseases, in particular, in gynecologic oncology, has been readily adopted and is partially replacing explorative laparotomy.The advantages are obvious, such as decreased morbidity, less hospitalization, earlier recuperation when urgent systemic treatments are considered, and better patient acceptance. However, the gold standard remains laparotomy, because of better tissue acquisition. Laparotomy normally harvests more and deeper tissue than does laparoscopy. Traditional forceps biopsies that accompany laparoscopies harvest only superficial samples from diseased areas and organs. With the coming of new direct and frontal (D&F) tissue biopsy systems, this shortcoming of laparoscopy could be significantly overcome. This article describes the first experience of laparoscopic tissue acquisition with D&F tools. Cases: The Spirotome ENDO (Medinvents nv, Hasselt, Belgium) is a new biopsy instrument with an external diameter of 5 mm and operational length of 40 cm. Different tissues from 4 patients were harvested under direct laparoscopic vision. Results: Tumor implants, uterine myoma, uterus, and ovaries were biopsied with equal ease. There were no complications. Bleeding was minimal and easily managed. The tissue specimens were all diagnostic and gave identical information to that from traditional surgical specimens. The Spirotome ENDO is easy to use in combination with laparoscopy. Conclusions: This feasibility study demonstrates that the D&F tissue acquisition approach under laparoscopic guidance provides enough high-quality tissue to diagnose and stage abdominal cancer. With these D&F tools, laparoscopic staging might become the standard approach for staging of gynecologic malignancies. (J GYNECOL SURG 27:235)
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