Prospective Randomized Comparison of Minilaparoscopy and Percutaneous Liver Biopsy

Abstract

Minilaparoscopic evaluation based upon the combined macroscopic and histologic assessment is more sensitive with regards to the detection of cirrhosis and has a comparable safety profile.

Mini-Laparoscopy Is Superior in Detecting Liver Cirrhosis and Metastases in Liver Cancer: An Over 10-Year Experience in 1,788 Cases

“…This sample error of liver biopsy has been described in 17-32% of cases in many previous examinations matching macro- and microscopic findings in chronic liver disease [5,13,14,15], including randomized trials that compared laparoscopy and mini-laparoscopy with percutaneous liver biopsy [6,16]. Histologic understaging of the liver disease seems to be more frequent in early (Child A) and macronodular cirrhosis [17] and is clearly dependent on the quality of the biopsy cylinder [18,19].…”

“…Due to the fact that inflammatory activity and fibrosis in chronic liver disease are heterogeneously distributed throughout liver tissue, histologic evaluation alone may cause a relevant sample error [5,6]. …”

Complications of Liver Biopsy

“…However, in their study the transjugular route had a low success rate and they suggested that the laparoscopic route as an alternative especially in patients with severe coagulopathy (Denzer, Helmreich-Becker, Galle and Lohse 2003). The only randomized study comparing laparoscopic with percutaneous biopsy was reported by Denzer et al (Denzer, et al 2007). This study was undertaken in cirrhotics but found a slightly higher but not significant difference in total complication rate between the groups (8.8% vs 5.8%).…”

“…In addition, staging of patients with cirrhosis and hepatocellular carcinoma who are being considered for resection can have a biopsy of the future liver remnant. Laparoscopic liver biopsy had the added advantage of direct view of the liver which reduces sampling errors and bleeding after biopsy allowing better control (Denzer, et al 2007). This is supported by Nord et al who reported a significant decrease in sampling errors of laparoscopic biopsy compared to the percutaneous route in cirrhotic patients (Tobkes and Nord 1995).…”

Confocal Laser Endomicroscopy: Applications in Clinical and Translational Science—A Comprehensive Review

“…In the first trial, a rigid confocal prototype probe of 6 mm outer diameter was based on the FIVE1-design with optical properties similar to eCLE and covered with a sterile metal sheath to allow for sterile intraabdominal instrumentation [67]. Under minilaparoscopic guidance and conscious sedation [68,69] the probe was positioned onto the liver, and imaging performed after fluorescein injection. Although basic features of the liver microarchitecture could be visualized, images could not provide sufficient details to allow exact diagnosis in liver diseases, probably due to the fact that the human liver capsule did not allow sufficient penetration of blue laser light to the parenchyma.…”