Minilaparoscopy versus conventional laparoscopy in the diagnosis of hepatic diseases

Background: Minilaparoscopy (ML) is being used increasingly in the diagnosi s of liver disease. This is a prospective study of the accuracy and safety of ML compared with conventional laparoscopy (CL) in the diagnostic workup of liver disease. Methods: One hundred four patients with suspected liver disease were random ized either to undergo CL (n = 50) or ML (n = 54). CL was performed with a standard Storz laparoscope (empty set 11 mm, Storz GmbH, Tuttlingen, German y) according to accepted guidelines. For ML a 1.9-mm small-diameter optical telescope was used (Richard Wolf GmbH, Knittlingen, Germany). In all cases , an attempt was made to obtain a liver biopsy specimen. Results: Laparoscopy could successfully be performed in 100 of 104 (96%) pa tients with simultaneous procurement of biopsy specimens of the liver. In 4 cases, postoperative adhesions prevented sufficient inspection of the live r and in another patient the technique was switched from C:L to ML for the same reason. Minor self-limiting bleeding at the biopsy site was observed i n 20% of CL and 15% of ML examinations. One patient in each group required surgery for uncontrollable bleeding from the biopsy site. The patients' sub jective perception of the examination was comparable in both groups. Compar ed with CL, ML could be performed in a significantly shorter time (27 vs. 2 2 min, p < 0.05). Liver cirrhosis diagnosed during laparoscopy was histolog ically confirmed in 77%, independent of the method of examination. Cirrhosi s was diagnosed by histology in 1 of 14 (7%) and 1 of 21 (5%) patients with out macroscopic signs of cirrhosis. Conclusions: Laparoscopy with a small diameter telescope in the workup of l iver disease is comparable in terms of results to CL. Possible advantages o f ML are a shorter examination time and a subjective impression of lower de gree of invasiveness.