Discussion
bleeding, ®, liver parenchyma coagulation, liver capsule hemorrhage, coagulation of the parenchyma
DRUG WITHDRAWAL, BLEEDING, BILE LEAK
This study showed that the device developed for video-assisted liver biopsy had a better mean procedure and biopsy time, in addition to safety and little risk of bleeding and bile leak compared to standard techniques for video-laparoscopic biopsy.Previous studies have shown that there is no direct correlation between post-biopsy bleeding and coagulation time when the liver biopsy was performed under direct visualization by laparoscopy [It is important to remember that in patients who are receiving anticoagulant therapy, such as aspirin, percutaneous biopsy should only be performed at least five days after drug withdrawal [In the present study, one patient in the control group had liver capsule hemorrhage (As bleeding control is one of the most important factors when performing liver surgeries, the present study brings an alternative for faster and less invasive liver hemostasis. The surgical model demonstrated in the experimental group shows the use of number 14 Jelco® as a portal for the passage of the biopsy needle. The liver parenchyma fragment is biopsied, and then the needle is kept in contact with the biopsy site, and then tissue cauterization is performed by touching the monopolar electric scalpel to the needle itself (there is no transmission to the skin, subcutaneous tissue or muscle as the Jelco® polyurethane catheter is insulating). Two major advantages are obtained with this method: (1) it does not require another portal to perform the hemostasis; (2) the fact that coagulation of the parenchyma is carried out with the needle itself reduces the time to perform the procedure. These data were confirmed by the measuring the time of hemostasis, which was significantly shorter in the experimental group compared to the control group (Another important aspect about the liver biopsy is the size of the biopsy sample and the excessive possibility of fragmentation of the biopsied liver parenchyma into small pieces [When the total time of the surgical procedure, time of biopsy and liver parenchyma coagulation time were compared, all findings were significantly lower in the experimental group than in the control group (This study has some limitations. First, the final sample size presented a lower statistical power than initially expected, recalculated with the same method at 70%. Despite not being an ideal power, this fact would contribute to not finding statistically significant differences that may exist in reality (type 2 error), so we understand that the differences found in the sample can be interpreted with confidence. In addition, laboratory-based biochemical changes were not evaluated in the present study.