Module 10

Question 1

How is a peritoneal washing done?

Answer 1

• Obtained early in staging laparoscopy
• 100c of 0.9% normal saline
• Gently agitate abdominal cavity and can tilt abdominal cavity
• Collect after 3-5 minutes in specific suction canister
• Sometimes need to mix w/ heparin solution

Question 2

What needle is used for FNA?

Answer 2

20-22 gauge, long like a spinal needle

Question 3

How is a core needle biopsy performed?

Answer 3

• Commonly used for liver (cirrhosis, carcinoma)
• AVOID for vascular lesions of liver
• 14-18 gauge needle (removed core of tissue for path evaluation)
• Higher risk of bleeding compared to FNA
• Hemostasis controlled with pressure, energy source, hemostatic agents, or sutures

Question 4

what is an incisional/wedge biopsy?

Answer 4

tissue sample from ONLY portion of lesion to allow pathologic diagnosis

Question 5

Biopsy forceps

Answer 5

Biopsy forceps: can do incisional or excisional
Incisional (larger lesion)
Excisional (smaller lesion)
Often used for peritoneal implants

Question 6

wedge biopsy

Answer 6

scalpel, scissors, or stapling device
Can be incisional or excisional
NO energy during biopsy, can use energy after for hemostasis

Question 7

what is taken in an excisional biopsy?

Answer 7

removing entire lesion for pathologic examination (better for small lesions)
Avoid using electrocautery as may distort tissue architecture, sterilize specimen, or alter results

Question 8

how many Ports for needle biopsies?

Answer 8

single port for camera and percutaneous needle

Question 9

How do you get a peritoneal lesion?

Answer 9

Small
Excisional biopsy w/ biopsy forceps or scissors
Large
Incisional biopsy with forceps or scissors
Can usually remove through 5-10mm port

Question 10

How is a LN biopsies?

Answer 10

RP, porta-hepatis, peri-pancreatic
Usually excisional biopsies
Careful dissection to prevent damage to LN or adjacent structures and bleeding
Can also use ultrasonic energy
Can use endo-loop for hemostasis
Can use hemostatic agents after excision
Removal:
Smaller nodes: directly through 10-12mm port
Larger nodes: place in a pouch

Question 11

Import tips for liver biopsy

Answer 11

Generalized parenchymal disease (cirrhosis)
- Core needle biopsy, wedge biopsy
Solid liver lesions
- Incision or excisional biopsy
- Core or wedge
- May need US to help locate lesion
Fluid filled liver lesions
- Usually do not require biopsy

Question 12

Ovarian biopsy

Answer 12

Biopsy technique based on menopausal status and suspicion for malignancy
- Suspicion for malignancy is high: consider oophorectomy
Can consider biopsy of anti-mesenteric portion
Can consider fenestration of cyst wall or wedge resection of solid lesion
Can also consider excision of entire cyst wall
- Hemostasis: bipolar or suture
Use frozen section to determine if need for oophorectomy and further staging
Specimen removal: avoid seeding malignant cells or causing ovarian remnant syndrome

Question 13

how do you do a visceral lesion biopsy?

Answer 13

Small and superficial: excise, and then place serosal stitch

Question 14

RP biopsy: to assess LN or unidentified mass

Answer 14

Can approach transperitoneal or RP
May need US to guide location
Avoid monopolar energy near vital structures

Question 15

what do you use for US guided bx?

Answer 15

often used with CNB of FNA

Question 16

How do you achieve hemostasis after bx?

Answer 16

Direct pressure
Monopolar or bipolar energy
US energy
Topical hemostatic agents
Sutures

Question 17

how are specimens removed?

Answer 17

Remove so there is minimal contact with tissue at removal site
Bring through port or in retrieval sac