Laparoscopic twist technique has the best overall artifact profile when comparing three laparoscopic hepatic cup biopsy techniques for dogs

Abstract

OBJECTIVE To determine the difference in histologic artifacts and morphologic diagnosis among 3 laparoscopic cup biopsy forceps techniques and wedge hepatic samples. ANIMALS Cadavers of 20 client-owned dogs following euthanasia for unrelated reasons between January 3 and July 29, 2021. PROCEDURES Four biopsy techniques were performed from the margin of 3 liver lobes/dog. Laparoscopic techniques used 5-mm cup biopsy forceps to obtain biopsy samples by pulling the forceps forcefully caudally to free a sample (the PULL technique), rotating the forceps 360° in 1 direction until freed (the TWST technique), or pulling the forceps through a 5-mm cannula to remove the sample (the CAN technique); wedge biopsy samples served as the control (CON). Data collected included sample weight, histologic features, diagnosis, and artifact characterization. Gwet AC1 or intraclass correlation coefficients (ICCs) were calculated to detect agreement among techniques. RESULTS Sample weights for CON and TWST were significantly larger (P < .001 and P = .035, respectively) than for PULL and CAN. There was excellent agreement among all techniques for most diagnostic features (Gwet AC1, 0.93 to 1). The TWST technique resulted in the best overall artifact profile for laparoscopic techniques, with 90% of samples (54/60) having crisp edges and 65% of samples (39/60) having no or mild tearing. The agreement was moderate to good (ICC, 0.73 for edges and 0.76 for tearing) among all cup biopsy forceps techniques. CLINICAL RELEVANCE The TWST technique resulted in the largest sample and had the fewest artifacts, supporting its continued use during laparoscopic procedures.

Comparison of the diagnostic yield of 3 and 5 mm laparoscopic liver biopsy forceps in cats

“…This is similar to the results of a recent study that described a twisting technique where 90% of samples had sharp edges and 65% of samples had mild to moderate tearing artifacts. 11 Although the TP technique resulted in greater tissue crush artifact, the median crush artifact was mild (grade 1), and a morphological diagnosis was still obtained in all tissue samples, so this finding may not be clinically relevant.…”

“…This may explain our lower agreement compared to a recent study that examined three samples using each technique and found excellent agreement for the diagnosis. 11 Having three veterinary surgeons with differing surgical experience perform the liver biopsies may also have influenced the size and quality of samples obtained. However, liver biopsies are routinely performed by veterinarians of varying experience, which might lead to some variability with any liver biopsy.…”

“…Several laparoscopic liver biopsy collection techniques have been reported. 8,9,11,12 Anecdotally, a twisting motion while obtaining a laparoscopic liver biopsy is thought to assist with hemostasis and was the primary technique used in several studies. 8,13 Most recently, Buote et al 11 determined that a 360 twist technique resulted in larger liver biopsy samples and fewer histologic artifacts in canine cadavers when compared to a pull technique and pull through a cannula technique.…”

“…8,9,11,12 Anecdotally, a twisting motion while obtaining a laparoscopic liver biopsy is thought to assist with hemostasis and was the primary technique used in several studies. 8,13 Most recently, Buote et al 11 determined that a 360 twist technique resulted in larger liver biopsy samples and fewer histologic artifacts in canine cadavers when compared to a pull technique and pull through a cannula technique. However, there is limited research in both cats and dogs that directly assesses differing laparoscopic liver biopsy techniques and the quality of samples obtained.…”

“…Several laparoscopic liver biopsy collection techniques have been reported 8,9,11,12 . Anecdotally, a twisting motion while obtaining a laparoscopic liver biopsy is thought to assist with hemostasis and was the primary technique used in several studies 8,13 .…”