Page 137 - Clinical Manual of Small Animal Endosurgery

Diagnostic Laparoscopy 125

(a)

(b)

Fig. 4.19 (a, b) Laparoscopic images of normal pancreas (duodenal limb).
Panel b shows a close up. Photographs courtesy of Mr P.J. Lhermette.

Haemorrhage from the biopsy site is addressed as for liver biopsies;
alternatively, pre-tied loop ligatures or haemostatic clips placed in a V
shape around the biopsy site can be used. Recently, a study evaluated
the use of the Harmonic Scalpel for collecting biopsy samples in dogs
(Barnes et al., 2006), comparing it with standard endoscopic instru-
ments. Using the Harmonic Scalpel resulted in less haemorrhage but
significantly greater inflammation.
In general, laparoscopic pancreatic biopsy has been demonstrated not
to induce significant pancreatic injury or inflammation in normal dogs.
However, minimising manipulation greatly decreases the risk of iatro-
genic pancreatitis. One or two samples are usually harvested from the
pancreas; liver biopsies are always collected at the same time, due to the
high incidence of concurrent liver disease.