Laparoscopy and biopsy in malignant liver disease.

Laparoscopy is highly effective in diagnosing malignant liver disease, with overall accuracy in the 90% range. Up to 80% of the liver surface can be inspected, and biopsies can be directed with precision. A major advantage over scan guided percutaneous techniques is the ability to detect and biopsy lesions only a few millimeters in size on the liver surface. Laparoscopy is useful in staging the liver for metastatic disease during evaluation for treatment of primary cancers. Small peritoneal metastases may also be discovered and biopsied. Primary liver cancers and isolated metastatic deposits can be assessed for resectability, and diagnostic laparotomy can often be avoided. Laparoscopy is safely performed under local anesthesia and mild sedation.