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A Technique of Liver Biopsy
A Technique of Liver Biopsy From the Section of Surgery, Lovelace Clinic, Albuquerque, New Mexico
JOSEPH G. RILEY, M.D.
THE USUAL METHOD of open liver biopsy during the course of an intraabdominal operation seems less than ideal because of the difficulty frequently encountered with the hemostatic sutures. In an attempt to improve the technique, the dermatologists' skin biopsy punch was modified into a straight cylinder of stainless steel with one end sharpened into a cutting edge and the other knurled. A slightly undersized stylet of solid stainless steel used as a "push-out" rod is he]pful. In use, an appropriate area of the liver is selected-usually about an inch back of the free margin-and a gauze flat is held under the proposed point of exit to avoid cutting the operator's glove and finger. The sharpened cylinder is passed through the full thickness of the liver with a rotary motion. When the cylinder has cut completely through, the
Fig. I
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JOSEPH
1416
G.
RILEY
Fig. 2
Fig. 3
stylet is pushed into the cylinder to discharge the biopsy specimen into the gauze and then is withdrawn. The cylinder is left in place and one small piece of Gelfoam is rolled between the palms, lengthwise, until it is a rod essentially the size of the cylinder or a little larger. This may be wrapped with Surgicel if desired. The cylinder is then withdrawn and this plug of Surgicel-wrapped Gelfoam, held in thin-shanked plain thumb forceps, is passed completely through the hole in the liver to protrude
A Technique of Liver Biopsy
1417
essentially the same amount on each side. Mild pressure with the thumb and index finger on the ends of the plug mushrooms the Gelfoam over each opening and effectively controls the bleeding. The advantages of this technique are simplicity, reliability and the securing of a representative full thickness liver biopsy for pathologic study. The photographs show the instrument and its use. The one shown is about 0.5 oentimetejtin diameter, but the size is not critical. The same technique using up ~1~"~a 2-inch cutting tool has been used, but with the larger sizes the holet,i filled with a Surgicel-wrapped Ivalon plug which is cut slightly oversize. fI"
JOSEPH G. RILEY, M.D.
THE USUAL METHOD of open liver biopsy during the course of an intraabdominal operation seems less than ideal because of the difficulty frequently encountered with the hemostatic sutures. In an attempt to improve the technique, the dermatologists' skin biopsy punch was modified into a straight cylinder of stainless steel with one end sharpened into a cutting edge and the other knurled. A slightly undersized stylet of solid stainless steel used as a "push-out" rod is he]pful. In use, an appropriate area of the liver is selected-usually about an inch back of the free margin-and a gauze flat is held under the proposed point of exit to avoid cutting the operator's glove and finger. The sharpened cylinder is passed through the full thickness of the liver with a rotary motion. When the cylinder has cut completely through, the
Fig. I
1415
JOSEPH
1416
G.
RILEY
Fig. 2
Fig. 3
stylet is pushed into the cylinder to discharge the biopsy specimen into the gauze and then is withdrawn. The cylinder is left in place and one small piece of Gelfoam is rolled between the palms, lengthwise, until it is a rod essentially the size of the cylinder or a little larger. This may be wrapped with Surgicel if desired. The cylinder is then withdrawn and this plug of Surgicel-wrapped Gelfoam, held in thin-shanked plain thumb forceps, is passed completely through the hole in the liver to protrude
A Technique of Liver Biopsy
1417
essentially the same amount on each side. Mild pressure with the thumb and index finger on the ends of the plug mushrooms the Gelfoam over each opening and effectively controls the bleeding. The advantages of this technique are simplicity, reliability and the securing of a representative full thickness liver biopsy for pathologic study. The photographs show the instrument and its use. The one shown is about 0.5 oentimetejtin diameter, but the size is not critical. The same technique using up ~1~"~a 2-inch cutting tool has been used, but with the larger sizes the holet,i filled with a Surgicel-wrapped Ivalon plug which is cut slightly oversize. fI"