Technical Note: Facilitating Laparoscopic Liver Biopsy by the Use of a Single-Handed Disposable Core Biopsy Needle

Despite the use of advanced radiological investigations, some liver lesions cannot be definitely diagnosed without a biopsy and histological examination. Laparoscopic Tru-Cut biopsy of the liver lesion is the preferred approach to achieve a good sample for histology. The mechanism of a Tru-Cut biopsy needle needs the use of both hands to load and fire the needle. This restricts the ability of the surgeon to direct the needle into the lesion utilising the laparoscopic ultrasound probe. We report a technique of laparoscopic liver biopsy using a disposable core biopsy instrument (BARD (R) disposable core biopsy needle) that can be used single-handedly. The needle can be positioned with laparoscopic graspers in order to reach posterior and superior lesions. This technique can easily be used in conjunction with laparoscopic ultrasound. 1. Introduction Increased availability of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) has resulted in incidental hepatic masses being reported more frequently. Indeterminate lesions especially in the cirrhotic liver often pose a diagnostic challenge. Specific radiological features such as a central scar in focal nodular hyperplasia or venous washout in hepatocellular carcinoma (HCC) are not always present. Colli et al. estimated 68% sensitivity and 93% specificity of spiral CT in diagnosing HCC compared with pathologic examination in their systematic review [1]. In a small number of cases—even with the use of 4-phase multidetector CT and contrast-enhanced MRI—a conclusive answer as to whether the lesion is benign or malignant or has a malignant potential might not be possible [2]. Laparoscopic Tru-Cut biopsy provides a definitive approach to determine the nature of a liver lesion. Percutaneous biopsy carries the risk of needle track or peritoneal seeding especially in the setting of a hepatocellular carcinoma [3, 4]. Laparoscopy and laparoscopic liver biopsy present an alternative and allows assessment of the peritoneal cavity to exclude advanced disease and gross liver cirrhosis in the same sitting. Lesions in the superior (2, 4a, 8) and posterior (6, 7) segments of the liver are technically challenging to biopsy during laparoscopy. A low lying and shallow rib cage combined with location of the lesions in the superior liver segments further increases the technical difficulty of laparoscopic liver biopsy. The biopsy needle may need to be introduced through the abdominal wall angled cephalad in order to reach the superior segments. A Tru-Cut biopsy needle often lacks the length to reach the lesion