What to Expect at your Ultrasound-Guided Liver Biopsy Procedure

On February 6th, 2020 I had a liver biopsy at Piedmont Hospital in Atlanta. At the time, I was living with an unofficial diagnosis of primary sclerosing cholangitis (PSC)— a non-alcohol-related, autoimmune, progressive liver disease. We hoped a liver biopsy would help give us some answers and confirm the unofficial diagnosis.

I was EXTREMELY nervous for my liver biopsy, but I couldn’t find much in-depth information about a patient’s personal experience anywhere on the internet.

So I’ve accumulated all my knowledge into a series of four blog posts, so if you or a loved one has an upcoming liver biopsy, you know exactly what to expect.

Here’s the table of contents so you can go straight to the parts you’re most curious about. Just please remember, this post is not medical advice! I’m speaking straight from my experience and my own research, and you should definitely follow the instructions from your medical team.

Table of Contents

• Waiting in the Surgery Room
• Why My Liver Biopsy was Done in the Radiology Department
• Three Types of Liver Biopsies
  • Type 1: Percutaneous
  • Type 2: Laparoscopic
  • Type 3: Transjugular
• Laying on the Operating Table
• What I Remember While Sedated: Ultrasound, Numbing Needle, and Holding My Breath
• The Actual Needle Insertion
• Risks of a Liver Biopsy
• Takeaways from My Experience
• But, How Do You Prepare For and Recover From a Liver Biopsy?

Part 1: The Procedure Itself

Waiting in the Surgery Room

I’m used to colonoscopies where the nurse wheels you back to the surgery room as the drugs are taking effect and making me loopy.

But for the biopsy, I wasn’t hooked up to the meds until I was inside the room. They needed me clear-headed to be able to verbally answer their questions: confirming my name, birthday, allergies, and reason for my visit (even though I had gone through this many times with several other nurses that day.) You know how that goes.

Why My Liver Biopsy was Done in the Radiology Department

My liver biopsy was completed in the hospital’s radiology department, not its hepatology (liver) department.

Why?

Because this hospital performs liver biopsies with the aid of an ultrasound machine. They used the ultrasound to find my liver and identify the best location to insert the needle.

Three Types of Liver Biopsies

There are three main types of liver biopsy. Your medical team may have a preference for you due to your medical history, current state of health, and other reasons.

Type 1: Percutaneous Liver Biopsy

This was the kind I had. The word simply means “to go through skin.” The doctor inserted a needle through my skin, between my ribs, and into my liver, pulling out a sample of liver tissue. This is the most common type of liver biopsy.

My surgeon supplemented this technique with the liver ultrasound beforehand.

Type 2: Laparoscopic Liver Biopsy

Similar to the first, a liver tissue sample is taken via a needle. But first, the doctor sends a lighted tube with a camera on the end into your abdomen. Then they insert the needle and pull out the tissue.

Type 3: Transjugular Liver Biopsy

In this procedure, a hollow tube is inserted down a vein in your neck into your liver. They send a contrast dye down the tube, and then remove a tissue sample through the tube. This type of biopsy is used if an individual has fluid in their belly or has blood clotting problems.

Laying on the Operating Table

After the full team assembled in my surgery room, they had me lay on my back, in the “banana” position—where you curve your right arm above your head. This tightens your skin and makes it easier to insert the needle.

Next, I felt the rush of fentanyl and Versed. I was both cold and SO nervous that I was trembling, but when the meds hit, my mind stopped racing. My body stopped shivering. I stopped freaking out.

The anesthesiologist asked, “Can you feel the medications?” My immediate thought in my head was, “What a dumb question, of course I feel it!” But instead, my voice just came out as a dopey, “Yuhh.”

What I Remember While Sedated: Ultrasound, Numbing Needle, & Holding My Breath

With this cocktail of meds and the mild amount they gave me, I did not fall asleep as I do for colonoscopies. I was meant to stay awake—a “conscious sedation”—so I could respond to verbal commands.

Of course, I wasn’t awake and alert as I am while I’m typing this, for example. I was drowsy, heavy, and fell into brief moments of light sleep.

I remember feeling the cold antiseptic wipe they used to clean my entire midriff. In my loopy state, I remember thinking, “They’re only inserting a needle, why do they need to wipe down my whole abdomen?”

Next, I felt the familiar, cool ultrasound gel dipping into my ribs. It tickled. Then, ouch! A sharp pinprick, like you accidentally stabbed yourself with a sewing needle. This must have been when they poked me with the smaller needle to numb the skin around my liver.

Luckily, only the skin has nerves—not the liver itself.

Then, before my skin went numb, I remember someone writing a giant “X” over my liver, and (I think) I heard the sound of someone replacing the cap back onto a marker. Though I wasn’t fully conscious, I knew they were marking where to insert the bigger needle. I knew what was coming next.

Then, the surgeon instructed me to hold my breath, which, funnily enough, I had absolutely no memory of until I started writing this!

The Actual Needle Insertion

So I held my breath. Now, this part HURT. I’m not sure if what I felt was the needle plunging into my liver or coming out with the tissue, but it felt like they were yanking my entire liver out of my body. I remember that I winced, my lips and eyes bunching up, and I wondered if they saw my face.

But, a moment later, the pain had vanished, and I was relaxed once again.

The best way I can describe it is this: For a brief moment, the pain was excruciating but irrelevant. 

After this, the biopsy was over. They had placed a bandage over the incision site and instructed me to turn onto my right side and to not move. They apparently wheeled me back to my recovery room (I have no memory of this).

I later found out that I was only under the anesthetic for 15 minutes!

Risks of a Liver Biopsy

One of the reasons why I was so afraid of getting my biopsy is because of the risks:

• Internal bleeding during or after the procedure: Though this risk is minimal, some people start bleeding internally. If it’s severe enough, these people usually need to either undergo surgery to stop the bleeding or get a blood transfusion.

• Infection: While this is also uncommon, there is a risk of getting an infection through the biopsy site or bloodstream.

• Accidental Injury to a Nearby Organ: It is rare, but possible, that during the biopsy, the gallbladder or lung could be punctured.

If you’re nervous about the risks and want to familiarize yourself with them and learn about what precautions your medical team will take, call your hospital.

The nurse who scheduled my appointment was my point of contact, and I called and emailed her about three times to ask questions and get mentally prepared.

Takeaways from My Experience

I’m thankful to say that my liver biopsy procedure was a success with no complications.

And I’m SO glad this hospital gave me both a sedative and a local numbness…some places only numb the incision site!

 If you have an upcoming liver biopsy, ask your medical team if getting a sedative is an option. I HIGHLY recommend looking into this! For me, it would have been impossible for me to hold my breath and lay still enough without it. 

Want to read the other 3 blog posts in this liver biopsy series?

Check them out here:

Part 2: How to Prepare for a Liver Biopsy (Plus Tips to Help You Safely Recover)

Part 3: 4 Types of Pain You Might Experience After your Liver Biopsy and How to Manage It

Part 4: 3 Major Things a Liver Biopsy Can Tell You (Plus 7 Common Reasons Why People Get the Procedure)

Questions?

Any questions about the liver biopsy procedure? Anything I left out? Please don’t hesitate to reach out in the comments or send me a message.

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Please remember: I am not a medical professional. The information in this blog post (and anywhere on my website and its affiliated social media channels) is simply me sharing my story, experience, and research. It does not take the place of medical advice from a licensed medical professional. Read the full medical disclaimer here.