Lap assisted liver biopsy
- Clotting factor check must be part of the pre surgery clinical pathology screens
- Place patient in left lateral recumbency
- Clip and surgical sterile preparation. Surgical clip area involves: along rib line, up to sublumbar muscles, down to midline, back to in front of hind leg.
- Place first port just behind ribs, midway between sublumbar muscles and midline.
- Use the Hassan technique of port placement – screw in with camera to ensure visualisation during port placement.
- Inflate the abdomen as for a laparoscopic ovariectomy, up to 12mmHg of pressure.
- Perform a laparoscopic internal examination before placing the second port.
- Place second port midway between ribs and HL, just below the sublumbar muscles.
- Place the telescope in the dorsal port and biopsy forceps in ventral port.
- Find the liver, always keeping your instruments in view, and determine the areas to be biopsied.
- Grasp a piece of liver with forceps, hold on for at least 30 seconds and pull.
- Observe this area and wait for clotting to be seen.
- Take at least 4 biopsy samples.
- Follow the port closure procedure as for a laparoscopic ovariectomy.