Vim-Silverman needle

In cirrhosis and fibrosis, the biopsy needle used will either be the Vim-Silverman needle or the Tru-Cut needle. Adequate tissue can thereby be obtained for assessment. Because of the increased bleeding tendency connected with these needle types, the diameter should not exceed 1.6 mm (which is generally not required anyway). The liver is punctured tangentially, mainly in the lateral area of the right lobe. Subsequent to the puncture, the stylet is removed, the outer cannula advanced, the inner needle sheath pushed forwards in a rotating movement out of the outer cannula before both are finally withdrawn together. 

After the catheter has been secured in the neck, it is directed subcutaneously to emerge through the parietal scalp behind the ear either by threading it onto a modified Kirschner wire or by directing it through the lumen of a large-bore Vim Silverman needle. 

Fig. 2. The catheter is directed subcutaneously using a Kirschner wire (A) or alternatively through a Vim Silverman needle (B) to emerge through a small incision in the parietal scalp behind the ear. With minimum trauma to the infant, the catheter is thereby placed in a long subcutaneous tunnel.

Both classical and modified types of biopsy needles are available suction needles (e. g. Menghini, Klatskin, and Jamshidi) and cutting needles (e. g. Vim-Silverman and Tru-cut) as well as spring-loaded needles. (12, 26, 86, 123, 129, 158, 162)... 

One of the first major compilations of statistics was produced by H. Thaler in 1964 in 23,382 biopsies, the lethality rate was 0.017% and the complication rate 0.10%. (158) In evaluating 79,381 liver biopsies, H. Lindner (1967) calculated a lethality rate of 0.015% and a morbidity rate of 0.34%. (85) In 19,563 liver biopsies, E. WiLDHiRT registered no fatal cases with a morbidity rate of 0.089%. (176) In a multicentre study carried out by F. PiccioNiNo et af, 68,276 liver biopsies were recorded during the period 1973-1983 with a lethality rate of 0.009% and a morbidity rate of 0.21%. In this study, the Vim-Silverman and Tru-cut needle types proved to have the highest risk rate (0.31% to 0.34%). (121) Severe complications were found in 0.57% of cases by J.F. Cadranel et al. (15) Among 4,124 of our own biopsies (Menghini needle), we registered no cases of death whatsoever from 1961 to 1987 the complication rate was 0.15% (s. tab. 7.7). 

A closer look at the publications, however, often reveals that some contraindications and problem situations (e. g. ascites, amyloid degeneration, liver tumours, leukaemia, obstructive jaundice) were not heeded. Likewise, inadequacies in applying the various methods may be responsible for complications. Biopsy needles with a larger diameter of >1.6 mm (e.g. Vim-Silverman, Jamshidi) were also found to involve greater risks. 

Due to their cutting action (which differs from the Menghini technique), Vim-Silverman and Tru-cut needles produce a sufficiently large and almost intact cirrhosis tissue sample. As a consequence, the false-positive results can be brought down to below 10%. Nevertheless, the risk of subsequent bleeding is clearly higher. For this reason, the diameter of the needle should not exceed 1.6 mm. 

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