Safety and feasibility of a new minimally invasive diagnostic laparoscopy technique.

BACKGROUND AND STUDY AIMS: Laparoscopy combined with guided liver biopsy offers many advantages in the diagnosis and staging of chronic liver diseases and is superior to other diagnostic procedures. We developed a new minilaparoscopic technique and evaluated the utility of this minimally invasive laparoscopic system in the first 320 patients who underwent diagnostic assessment for liver disease or peritoneal carcinosis.

PATIENTS AND

METHODS

Between July 1996 and February 1998, minilaparoscopy, with analgesia and sedation was carried out in 320 patients. It was done 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. Thus only a single puncture of the peritoneum was required. Liver biopsies, when indicated, were obtained under laparoscopic control with the Silverman needle through a short 2-mm additional trocar when the Menghini technique was used.

RESULTS

Complication rates, patient discomfort and duration of procedure were extremely low with minilaparoscopy. We observed no serious complications, two complications that could be treated conservatively and technical difficulties in eight of 320 patients, which prevented liver biopsy in 2.8%. These minor difficulties all happened during the first 40 procedures, whereas after the initial 40 examinations of each investigator no further difficulties arose.

CONCLUSIONS

This new minilaparoscopic technique allows a macroscopic and histological diagnosis of liver disease with minimal invasiveness, easy handling, excellent patient tolerance, and also a high degree of safety in patients with coagulation defects. Exploratory laparoscopy is an accurate and safe method for intra-abdominal diagnosis of liver diseases and peritoneal carcinosis.