Diagnostic laparoscopy.

Diagnostic laparoscopy is increasingly being used to aid decision-making in the treatment of serious diseases. The majority of papers on the topic published during the last year have been concerned with preoperative assessment of malignant diseases of the gastrointestinal tract, and have shown that laparoscopy alone--or, even better, in combination with laparoscopic ultrasonography--is able to identify metastatic disease and therefore to reduce significantly the risk of unnecessary laparotomies. New techniques such as the application of fluorescent dyes may improve these results even further. Surgeons are increasingly using diagnostic laparoscopy in patients with acute abdomen and abdominal trauma--a minimally invasive strategy that should also be supported by gastroenterologists. Close cooperation between surgeons and gastroenterologists can also be promoted by using laparoscopy in critically ill patients in intensive-care units when a decision needs to be taken on whether or not laparotomy should be performed. The technique of diagnostic laparoscopy is returning to widespread use after a period of decline.