TECHNIQUE

Liver Biopsy in Rabbits (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords --
Description
  • Note: prior to taking a biopsy in a patient with suspected compromise of liver function, assess blood clotting parameters. (J29.9.w1)
  • Sedate and restrain, or anaesthetise the rabbit. See: Treatment and Care - Anaesthesia and Chemical Restraint
Ultrasound guided percutaneous biopsy
  • Place the rabbit in oblique dorsal recumbency, at a 30 to 45-degree angle, right side to the table.
  • Clip the abdomen and prepare for ultrasonography. 
  • Visualise the liver using ultrasonography to determine a safe needle track, not involving major vascular structures or the gall bladder. See: Imaging in Lagomorph Diagnosis and Treatment - Ultrasonography
  • Aseptically prepare the skin from over the tip of the xiphoid to the left costal arch and caudally to the umbilicus.
  • Cover the ultrasound transducer with a sterile sleeve.
  • Use sterile coupling solution on the skin.
  • Make a small stab incision in the skin using a Number 11 scalpel blade.
  • Under ultrasonographic guidance, insert the biopsy device:
    • Pass the biopsy needle or device through the skin incision and through the abdominal wall on a path parallel or slightly perpendicular to the ultrasound transducer path.
    • Advance the needle to the edge of the lesion or liver lobe.
    • Take a biopsy of the appropriate area or mass - advance the needle biopsy notch into the selected area and fire it.
    • Withdraw the biopsy needle.
      • Retrieve the sample from the biopsy needle using a sterile 25-gauge needle.
    • Scan the liver for signs of haemorrhage (an area of hyperechogenicity in the area of the biopsy).

(B533.142.w142, J281.173.w1, J29.9.w1)

Endoscopic biopsy
  • Enter the abdomen using a ventral midine approach.
  • Visualise the liver.
  • Advance the biopsy forceps towards the appropriate part of the liver
  • Take a biopsy from the liver lesion.
  • Note: it is common for minor haemorrhage to be present following biopsy.
  • For further information on endoscopy see Imaging in Lagomorph Diagnosis and Treatment - Endoscopy

(J29.9.w1)

Biopsy during laparotomy
  • Note: prior to taking a biopsy in a patient with suspected compromise of liver function, assess blood clotting parameters. (J29.9.w1)
  • Laparotomy incision and abdominal exploration: see Laparotomy in Rabbits
  • Identify and isolate the area of interest in the liver.
  • 1) Biopsy punch technique
    • Apply a skin biopsy punch to the required area of liver.
    • Rotate the punch in one direction until it is completely in the liver.
    • Remove the punch from the liver; the biopsy usually remains in place in the liver.
    • Detach the biopsy from the liver using a No. 11 scalpel blade.
    • Stop any bleeding by application of a haemostatic agent into or over the biopsy site.

    (B601.17.w17)

  • 2) Guillotine suture biopsy
    • Make a loop in a piece of absorbable suture material.
    • Make the first throw of a square knot.
    • Pull a peripheral piece of liver through the loop.
    • Tighten the loop around the piece of liver.
      • This crushes the liver parenchyma and ligates blood vessels.
    • Complete the knot.
    • Cut off the isolated piece of liver using a scalpel or cautery.
    • Stop any bleeding by application of a haemostatic agent into or over the biopsy site.

    (B533.142.w142, B601.17.w17)

  • 3) Excisional wedge biopsy (J29.9.w1)
    • Place a row of overlapping interrupted mattress sutures through the full thickness of the liver parenchyma in a "V".
      • These should achieve haemostasis and not cut through the liver parenchyma. 
    • Cut through a wedge of liver within the area marked off by the sutures.

Post-surgery

  • Place the rabbit in sternal recumbency; in this position the liver's own weight assists in compressing the biopsy site and reducing haemorrhage. (B533.142.w142)
  • Monitor for signs of haemorrhage for several hours, whatever technique has been used. (B533.142.w142)
Appropriate Use (?)
  • Diagnosis and assessment of pathological abnormalities of the liver, e.g. 
    • Liver neoplasia.
    • Diffuse disease of the liver.
    • Liver masses
    • Assessing progress of liver disease treatment.
    • Assessment of heavy metal or other toxin levels.

(B533.142.w142, B601.17.w17, J29.9.w1)

Ultrasound guided percutaneous biopsy

  • May be carried out without the need for full general anaesthesia; this may be advantageous in a patient with severe liver disease. (B533.142.w142)
  • Allows visualisation of the liver, selection of a biopsy site (particularly useful for focal lesions) and avoidance of major vasculature structures and the gall bladder. (B533.142.w142, J281.173.w1)

Endoscopic biopsy

  • Allows visualisation of the liver and other abdominal organs. (B533.142.w142)
  • Only a small incision is required. (B533.142.w142)
  • The biopsy can be directed into a small liver or a focal lesion. (B533.142.w142)

Biopsy during laparotomy

  • Porvides good visualisation of the liver and of other abdominal organs. (B533.142.w142)
  • Provides direct visualisation of the biopsy site. (B533.142.w142)
  • Allows control of haemorrhage. (B533.142.w142)
Notes
  • Place the biopsy (or a portion of the biopsy) in 10% buffered formalin for histopathology.
  • Place the biopsy in appropriate transport medium for bacteriological culture.
  • Check with the laboratory beforehand for sample storage and transport conditions for toxicological testing.
Complications/ Limitations / Risk
  • Haemorrhage may occur at the biopsy site. (B533.142.w142)
    • Note: prior to taking a biopsy in a patient with suspected compromise of liver function, assess blood clotting parameters. (J29.9.w1)
  • Puncture of the biliary system, stomach or intestines may occur. (B533.142.w142)

Ultrasound guided percutaneous biopsy

  • Not suitable if the liver is small and fibrotic, highly vascular, or contains a cyst or abscess (B533.142.w142)

Endoscopic biopsy

  • Requires expensive equipment. (B533.142.w142)
  • Considerable operator experience is needed. (B533.142.w142)
  • Requires general anaesthesia. (B533.142.w142)
  • More difficult if moderate to severe abdominal effusion is present. (B533.142.w142)

Laparoscopic technique

  • Requires general anaesthesia, which can cause decompensation in a patient with severe liver disease. (B533.142.w142)
  • Recovery from general anaesthesia may be poor. (B533.142.w142)
  • There may be problems with haemorrhage, poor wound healing and dehiscence of the laparotomy incision in patients with liver disease. (B533.142.w142)
Equipment / Chemicals required and Suppliers
  • Anaesthetic or sedative drugs as appropriate.

Ultrasound guided percutaneous biopsy

  • Ultrasound equipment.
  • Biopsy needle or other biopsy device.

Endoscopic biopsy

  • Endoscope with biopsy forceps. 

Laparoscopic technique

  • Surgical kit, including e.g. suture materials. 
Expertise level / Ease of Use
  • This procedure should only be carried out by an individual with appropriate clinical training and practical experience; this would normally be someone with a veterinary degree.
Cost/ Availability

The costs of a surgical operation include those associated with: (J15.30.w1)

  • Pre-operative diagnostics (e.g. radiography, ultrasonography, blood tests)
  • Anaesthesia.
  • Perioperative medication (e.g. analgesics, antibiotics, fluids).
  • Surgical preparation (of the operating theatre and the patient, including staff time).
  • Consumables and equipment.
  • Time of the surgeon and assistant(s).
  • Post-operative hospitalisation.
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Frances Harcourt-Brown BVSc FRCVS (V.w140)
References B533.142.w142, B601.17.w17, J15.30.w1, J29.9.w1, J281.173.w1

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