Lap assisted liver biopsy

Step-by-step

Section 1 of 4

  1. Blotting factor check must be part of the pre surgery clinical pathology screens
  2. Place patient in left lateral recumbency
  3. 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.

Section 2 of 4

  1. Place first port just behind ribs, midway between sublumbar muscles and midline.
  2. Use the Hassan technique of port placement – screw in with camera to ensure visualisation during port placement.
  3. Inflate the abdomen as for a laparoscopic ovariectomy, up to 12mmHg of pressure.
  4. Perform a laparoscopic internal examination before placing the second port.
  5. Place second port midway between ribs and HL, just below the sublumbar muscles.

Section 3 of 4

  1. Place the telescope in the dorsal port and biopsy forceps in ventral port.
  2. Find the liver, always keeping your instruments in view, and determine the areas to be biopsied.
  3. Grasp a piece of liver with forceps, hold on for at least 30 seconds and pull.
  4. Observe this area and wait for clotting to be seen.

Section 4 of 4

  1. Take at least 4 biopsy samples.
  2. Follow the port closure procedure as for a laparoscopic ovariectomy.