7006 Laparoscopic wedge biopsy of the liver with use of laparoscopic coagulating shears under local anesthesia.

Abstract

Wedge biopsy of the liver is more useful compared to needle biopsy for the diagnosis of the liver diseases, especially for the diagnosis of primary biliary cirrhosis or primary sclerosing cholangitis. Wedge biopsy has been done under open laparotomy or laparoscopy with general anesthesia. This method was more invasive than needle biopsy. We performed wedge biopsy laparoscopically under local anesthesia with use of laparoscopic coagulating shears (LCS; Johnson & Johnson Medical, K. K., Tokyo, Japan) from May 1998. LCS is ultrasonically activated scalpel and is a high-frequency oscillating instrument that has both coagulating and dissecting activities. Five patients underwent this wedge biopsy from May 1998 to November 1999. In the five patients, three had autoimmune hepatitis, one had primary biliary cirrhosis, and one had non-alcoholic steatohepatitis. Following the pneumoperitoneum with room air, a 10-mm trocar was punctured at upper right side of umbilicus and a peritoneoscopy was inserted through the trocar. After observation of the surface of the liver as usual, a 10-mm trocar was punctured at upper left side of umbilicus under laparoscopic observation. A LCS were inserted through this trocar. The edge of the liver at subsegment 3 or 4 was dissected with the LCS under output of level 3 as described by the company. Subsequently, the peritoneoscopy and the LCS were pulled out through the trocars. And the peritoneoscopy was inserted through left-side trocar and the LCS was through right-side trocar. The opposite side of the dissected edge was resected with LCS. During resection of the liver, the patients complained slight abdominal pain but no troubles were observed. The wedge biopsied specimens were pulled out with a 5-mm forceps through the trocar. The bleeding was few and no serious complications were found. Tissues were placed in formalin for histological examination. Microscopic findings showed mild injury along the dissected portion but the central area of the specimens were intact. So no troubles for the diagnosis of the tissues were experienced. Compared to needle biopsy, more sufficient amount of tissues were obtained with this method. After laparoscopic wedge biopsy, all 5 patients complained mild abdominal pain and slight fever. But these symptoms were same degree as of the patients after laparoscopic needle biopsy. Conclusions: Laparoscopic wedge biopsy with LCS under local anesthesia was safe and more useful compared to needle biopsy. And this method was no more invasive than needle biopsy.