Diagnostic and therapeutic laparoscopy. An entity often overlooked by the surgeon.

For unknown reasons, only a few surgeons have become interested in diagnostic and therapeutic laparoscopy. Electronic imaging, the recent adjunct to endoscopy, has enhanced its value. In problematic cases, it is not only important to establish the diagnosis but also to be able to demonstrate the interesting findings during weekly conferences or to reevaluate or recapitulate the findings in the follow-up period. Ascites, pyrexia, abdominal pain with weight loss of unknown origin, a palpable mass, suspected primary or secondary liver tumors, staging, second look, and questionable operability of known primaries are examples of the indications for laparoscopy. If intra-abdominal malignancy is suspected, a computed tomographic (CT) scan or ultrasonic examination is the common current procedure. If liver or parietal peritoneal involvement is present, these costly examinations will not display lesions smaller than 1 cm, whereas they can often be seen during laparoscopy. Repeated CT or ultrasound examinations with guided needle biopsies have a high incidence of noninformative (cytological) specimen retrieval. Laparoscopy, providing a precise, well-aimed biopsy, can be performed under local anesthesia following premedication. It represents an important advantage for high-risk patients because it can be performed with a negligible incidence of complications.