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Compendium April 2009 (Vol 31, No 4)

Laparoscopic Biopsy Videos

    The April 2009 Surgical Views column, "Techniques for Laparoscopic and Laparoscopic-Assisted Biopsy of Abdominal Organs," by Dr. Philipp Mayhew, describes laparoscopic techniques that can be used to harvest biopsy samples from the liver, kidneys, pancreas, and gastrointestinal tract. Six videos, contributed by Dr. Mayhew and Stephen J. Mehler, DVM, DACVS, demonstrate the use of some of the techniques and instruments discussed in this article.

    Video 1: Laparoscopic Liver Biopsy with Cup Forceps
    This video shows the technique for laparoscopic liver biopsy using a 5-mm laparoscopic cup forceps. The liver lobe is grasped and gently twisted until a piece of liver parenchyma separates from the lobe. Some bleeding almost always occurs but is rarely significant. A piece of gelatin sponge (Gelfoam, Pfizer Inc) can be seen being placed into the second biopsy site to improve hemostasis. This video has been edited and speeded up and does not depict the entire procedure.

    Video 2: Laparoscopic Liver Biopsy with Loop Ligature
    In this video, a pretied loop ligature (Endoloop, Ethicon Endosurgery Inc) is placed around the tip of a liver lobe before the biopsy sample is taken. Once around the tissue, the loop is tightened before the liver tissue is cut distal to the ligature. Cup forceps can also be used to collect multiple pieces of ligated tissue. Note the large amount of ascites in this dog's peritoneal cavity. This video has been edited and speeded up and does not depict the entire procedure.

    Video 3: Laparoscopic Kidney Biopsy
    A laparoscopic kidney biopsy technique using a 14-gauge spring-loaded needle core biopsy needle is demonstrated in this video. The biopsy needle is passed through the abdominal wall and into the kidney at an oblique angle to achieve passage through the cortex. This ensures that a maximal number of glomeruli are harvested for examination. This video has been edited and speeded up and does not depict the entire procedure. (Courtesy of Stephen J. Mehler, DVM, DACVS, Michigan State University)

    Video 4: Wound Retractor Placement
    This video demonstrates placement of the Alexis wound retractor (Applied Medical Inc). The surgeon inserts the single green plastic ring into the peritoneal cavity and elevates it slightly, taking care not to trap any abdominal organs between the ring and the body wall during placement. The double white ring is then rolled down on itself until it is snug with the abdominal wall and circumferential force is exerted on the edges of the incision. This video has been speeded up.

    Video 5: Exteriorization of Intestinal Mass
    This video shows the surgeon "running" the small intestine extraperitoneally. A large focal intestinal mass is seen and exteriorized. This video has been speeded up.

    Video 6: Pancreatic Biopsy
    This video demonstrates the use of 5-mm cup biopsy forceps to harvest a pancreatic biopsy sample from the periphery of the right pancreatic limb. This video has been edited and speeded up and does not depict the entire procedure. (Courtesy of Stephen J. Mehler, DVM, DACVS, Michigan State University)

    NEXT: Laparoscopic Liver Biopsy with Cup Forceps

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