Chapter 12: Table of Contents
Punch Biopsy Technique
The punch biopsy technique is useful to biopsy a mass or lesion that involves the middle portion of a liver lobe. I use a 4 or 6 mm punch. This technique is generally safe for the diaphragmatic surface of the lobes but is more risky on the visceral surface especially close to the hilus where the vessels are larger! A partial thickness (less than 50% of the lobe thickness) punch biopsy sample can be collected.
Apply digital pressure to the hole created in the liver lobe. If bleeding persists, fill the defect with a small piece of absorbable gelatin sponge (Gelfoam®). I typically pre-cut a few gelfoam cylinders using the dry biopsy instrument and then use it to biopsy the liver. One to two gelfoam cylinders can be placed in the defect to control hemorrhage and digital pressure applied for approximately 1-minute to control hemorrhage.