Association Professor Cornell University College of Veterinary Medicine
Laparoscopic cup biopsy forceps (LCBF) are the most common instrument used for laparoscopic liver biopsies, but artifacts can occur depending on the technique used. Our objective was to determine the histologic artifacts created between three LCBF techniques on hepatic samples. An experimental cadaver study on 20 client-owned dogs presenting for euthanasia was performed. The PULL technique: forceps jaws forcefully pulled caudally; the TWST technique: forceps twisted 360° until freed from the parenchyma; the CAN technique: forceps pulled through a 5mm cannula to remove the sample. A wedge liver sample acted as the control. Data collected included the weight of each sample, histologic diagnostic features, diagnosis, and artifact characterization. The wedge biopsy yielded a significantly (P < 0.0001) larger sample, followed by the TWST method (mean 0.47 g, SD ±0.06 g). There was excellent agreement among all sampling techniques for most diagnostic features (Gwet AC1 0.93-1). The TWST technique resulted in the best overall artifact profile after the wedge, with 90% crisp edges and 65% of samples having no-mild tearing. All tested biopsy techniques appropriately identified the morphologic diagnosis. The TWST technique appears to be the best LCBF technique for hepatic biopsies. The main limitation to the study was the use of samples from recently euthanized patients which did not allow us to assess for bleeding differences between the techniques. All tested biopsy techniques appropriately identified the morphologic diagnosis and therefor can be used confidently but the TWST technique resulted in the largest sample and had the least artifacts.
