The liver is the largest organ of the human body. The liver performs many endocrine (a complex network of glands and organs) and exocrine (gland that makes sweat, tears, milk, and digestive juices) functions and plays a vital role in the detoxification process of the body. You cannot live without your liver completely; you can live with one part of it. Many habits and diseased conditions affect the liver, and many tests and investigations are done as a part of diagnostic procedures to identify the cause and diagnose the treatment for the situation. One such test diagnostic procedure is liver biopsy.

What Is Laparoscopic Liver Biopsy?

Laparoscopy is a minimally invasive procedure. In a liver biopsy, part of or a small amount of tissue from the diseased site of the liver is taken for its investigation and checked under a microscope, and cultured to identify the cause of the condition. Taking this tissue sample along with the laparoscopic technique is known as laparoscopic liver biopsy. A liver biopsy can identify and differentiate normal cells and cancerous cells.

What Are the Types of Liver Biopsy?

There are three main types of liver biopsy:

Percutaneous Liver Biopsy: A needle is used to take a sample, and the individual is anesthetized while taking a sample. It is the most common method.
Transvenous Liver Biopsy: In this method, a neck incision is made, and a hollow tube is inserted into it; a dye is injected into the tube; this dye helps in precisely locating the pathway of veins in X-rays. A needle is passed through the same tube, and a tissue sample is taken through it. This method is widely used in people with blood clotting issues and ascites (fluid-filled in the belly); it is also done under general anesthesia.
Laparoscopic Liver Biopsy: A minimally invasive procedure in which the individual is anesthetized. A small incision is made on the skin, and two small hollow tubes are passed through it. One has a video camera attached to find the location. The image is visible on the monitor attached to the system, and the other tube is used to take the required sample from the site.

Are Laparoscopic Liver Biopsies Safe?

In most cases, liver biopsies are safe; around 95 % of it is successful in the removal of the sample with no complications. But in rare cases, complications do occur like internal bleeding, pneumothorax (when accidentally the needle used to take sample pricks the chest wall), or resulting in any kind of bile leak in the liver bile duct or gallbladder.

Why Is a Laparoscopic Liver Biopsy Performed?

Laparoscopic liver biopsy is the best test to rule out liver damage or diseased condition.
It helps to diagnose the conditions which could not be diagnosed with blood and imaging tests.
It helps in the identification of a process called staging, the estimation of liver damage.
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Condition when abnormal and unexplained liver test results appear.
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What Are the Stages of Certain Liver Diseases Where Laparoscopic Liver Biopsy Is Indicated?

Stage certain liver diseases are:

Primary Sclerosing Cholangitis: A disease of the liver where the inside of the bile duct becomes inflamed and scarred, which is chronic.
Hemochromatosis: Excess iron absorption in the body, which leads to life-threatening conditions.
Wilson's Disease: A rare inherited disease that results in excess copper accumulation in the liver, brain, and vital organs.
Nonalcoholic Fatty Liver: Liver disease occurs in people who have no alcohol habit.
Chronic Hepatitis B and C: Liver disease affected by viral infection.
Alcoholic Liver Disease: A liver disease caused by excess alcohol consumption.
Primary Biliary Cirrhosis: Disease of the liver that causes bile duct destruction.
Autoimmune Hepatitis: When the body’s immune cells attack the normal cells causing a diseased condition.

How to Be Prepared for Liver Biopsy?

A detailed history of past medical and allergies is recorded.
A complete physical examination and routine blood tests are done before the test.
Any kind of medicine or latex allergies are taken into consideration.
Do inform the health care provider if you are taking any over-the-counter medications, herbs, or supplements.
Do inform the health care provider if you have any kind of bleeding disorder or if you are taking any NSAIDs (blood thinners) medications such as Aspirin or medications that may affect the blood clotting.
If you have an ongoing pregnancy or are expecting to be positively pregnant, avoid the tests and do inform your healthcare provider the same.
You might be instructed not to consume any kind of food at least a night before the test, as the test is done under sedation.
You might need an assistant to drive back home as the drowsy effect of sedation may last longer than expected.

How Is the Procedure Performed?

A GA (General anesthesia) will be given, which will make you asleep and pain-free.
A small incision is made in your abdomen along with two to three other small incisions.

The laparoscope is inserted. It is a long metal tube that has a light and camera on the end.
Along with the laparoscopic camera, three other laparoscopic instruments are placed in other incisions.
The abdomen is inflated with carbon dioxide (gas), which lifts the abdomen away from organs and provides more space to access and work.
Meanwhile, a tool is used to remove the required amount of sample from the liver.
The incisions made will be glued or stripped with a bandage.
Do not get up from the bed till your health care provider approves it.
You might have post pain in your abdomen region and right shoulder, which may subside within 48 to 72 hours.
If pain medications are provided by the provider, you can take them.

In What Condition Should We Consult a Doctor Immediately After a Laparoscopic Liver Biopsy?

If the following condition occurs, contact your health care provider immediately:

Fever or chills.
Severe consistent pain at the site of the biopsy.
Troubled breathing or breathlessness.
Rectal bleeding.
Swelling, redness, or leak of any kind of fluid at the site of biopsy.
Dizziness and chest pain.

Conclusion:

Recovery after biopsy takes around two to three days; avoid lifting heavy materials, exercise, and exertional activities. The sample removed during the biopsy goes to a pathologist for its investigation, and the lab report test takes around a few days to get an analyzed report.

Despite many advancements in diagnostic imaging techniques, many lesions remain unrevealed. Laparoscopic liver biopsy serves as a boon in such cases and helps in a clear early diagnosis of such diseased conditions.