Chapter 12: Table of Contents
Pancreatic biopsies can be performed at the edge of a pancreatic lobe for generalized disease or at the level of a specific lesion, but you must know the anatomy of the pancreas. Biopsies are typically performed away from the main blood supply and pancreatic ducts and are therefore most commonly obtained from the most caudal edge of the right pancreatic lobe. Small biopsy samples of a specific mass lesion can be obtained by shaving off a small amount of pancreas with a blade. A biopsy sample can also be obtained by dissecting a few lobules and ligating the small vessels or ducts associated with it (similar to a mini-guillotine biopsy) using 4-0 or 5-0 absorbable suture material. Clamshell biopsy forceps can also be used to remove a small sample of pancreas at its edge – this instrument is used to obtain laparoscopic pancreatic biopsies. Ligation is not necessary when using this technique.