7005 Evaluation of a minilaparoscopical technique in the diagnosis of liver diseases.

INTRODUCTION: Explorative laparoscopy combined with guided liver biopsy offers many advantages in the diagnosis and staging of liver diseases. Its use might be limited by the invasivity of the technique and the development of non-invasive diagnostic imaging techniques, respectively. In the present publication we report about a minilaparoscopic technique that uses miniaturized scopes to reduce the risc of trauma. PATIENTS AND METHODS: Between April 1999 and Novembre 1999 30 patients (6 females and 24 males) underwent diagnostic assessment for chronic liver disease by minilaparoscopy. The mean age was 56 years in the female patients (range:27 to 73 years) and 43 years in the male patients (range: 20 to 72 years). Minilaparoscopy was performed in local anesthesia and weak sedation using a 1.9 mm optical instrument, which was inserted through the same 2.75 mm trocar as the Veress needle used for inflating the pneumoperitoneum. The minilaparoscop was connected to a video converting system that enabled monitoring on a video scope. Liver specimens were obtained under laparoscopical sight through an additional 2.3 mm trocar. RESULTS: Minilaparoscopy could be performed in all 30 patients without any severe complications. In one of the initial cases liver biopsy was not performed because of technical difficulties. In all other patients it was performed without any limitations. Macroscopic evaluation of the liver revealed a steatosis in 4 cases (histological diagnosis idem), acute hepatitis in 2 cases (histological diagnosis idem), cirrhosis in 7 cases (agreement with histological diagnosis in 6 cases), and no sighns of cirrhosis in 16 cases (histological diagnosis idem). In one patient a disseminated peritoneal carcinosis was found that appeared histologically as a low differenciated adenocarcinoma. CONCLUSIONS: The minilaparoscopical technique allows macroscopic and histological diagnosis of liver diseases with a minimum of invasiveness. It is tolerated excellent by the patients and is a safe technique. It is concluded that explorative minilaparoscopy is a useful technique in the diagnosis of liver diseases and peritoneal carcinosis.