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Laparoscopic Technique & Patient Outcome

Clinician's Brief (Capsule)

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Described techniques for liver biopsy in dogs include fine-needle aspiration, ultrasound-guided percutaneous core needle biopsy, celiotomy, and minimally invasive laparoscopic liver biopsy (LLB). LLB combines the benefits of minimally invasive surgery with the ability to grossly visualize the liver and collect larger samples in an optimal location. There are potential drawbacks to LLB, including technical difficulty and potential for uncontrollable hemorrhage, necessitating conversion to open laparotomy. The rate of these complications, however, is unknown. The records of 106 client-owned dogs that underwent LLB were reviewed retrospectively to determine the complication and conversion rates associated with single or multiport LLB in 2 veterinary teaching hospitals. Of the 94 dogs with coagulation profiles present in the record, 25/94 (26.6%) had a coagulopathy prior to surgery. Of these, 84 had automated platelet counts performed (21/84, or 25%, were thrombocytopenic) and 10 had adequate platelet numbers on manual blood smear. Fourteen dogs, 10 of which were coagulopathic, received fresh frozen plasma before surgery. The multiport technique was used in 99/106 dogs, and the single port technique was used in 7/106 dogs. All patients had a sample of diagnostic quality obtained. Splenic laceration during port placement required conversion to an open laparotomy in 2/106 dogs. No other intraoperative complications were recorded. Five dogs were euthanized before discharge for reasons unrelated to the procedure. The authors concluded that both single and multi-port LLB are safe, effective, minimally invasive diagnostic techniques with low rates of complications. 

Commentary

Laproscopic liver biopsy (LLB) is an attractive minimally invasive option for obtaining diagnostic quality liver samples. All procedures were performed or directly supervised by a board-certified surgeon with extensive laparoscopic experience. Therefore, technical difficulties or complications associated with port placement would be expected to be low, as was the case in this study. Before conclusions on the safety of LLB are made, a follow-up study should be performed comparing complication and conversion rates when LLB is performed by practitioners of various surgical skill levels. Because 7/106 dogs underwent single-port LLB, there is insufficient power to make a statement on safety of this technique. It is recommended that the operating veterinarian acquire sufficient training in laparoscopic technique in a controlled setting before attempting this procedure on a clinical patient.—Sara Colopy, DVM, PhD, DACVS

References

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