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Laparoscopic twist technique has the best overall artifact profile when comparing three laparoscopic hepatic cup
Nicole J Buote1, John P Loftus2, Andrew D Miller3
1Department of Clinical Sciences, Section of Soft Tissue Surgery, College of Veterinary Medicine, Cornell University, Ithaca, NY.
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.
