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Laparoscopic vs conventional autopsy. A promising perspective.

OBJECTIVE
To analyze the sensitivity and specificity of laparoscopic autopsy when compared with the ulterior performance of conventional postmortem examination.


DESIGN
Consecutive sampling, case-series study.


SETTING
A general community referral medical center and the local institute of forensic medicine.


PARTICIPANTS
A consecutive sample of 25 fresh cadavers (< 24 hours old) of victims of vehicle accidents, gunshot wounds, and in-hospital deaths.


INTERVENTIONS
After insufflation with carbon dioxide, laparoscopy of the abdominal cavity and inspection of the retroperitoneal area was accomplished. Following, a conventional postmortem examination was performed and the findings of both procedures were recorded, compared, and analyzed.


MAIN OUTCOME MEASURES
Prior to the beginning of the study, it was hypothesized that laparoscopic autopsy would reach an overall sensitivity and specificity of at least 85% and enable accurate inspection of the abdominal cavity and retroperitoneum in the search for the trauma-related cause of death in trauma victims or the cause of death for in-hospital patients.


RESULTS
There was a 100% correlation of both procedures in all accidental cases. The sensitivity of laparoscopic autopsy was 93% for intra-abdominal lesions, with an overall sensitivity of 91%. For the retroperitoneal area, the sensitivity was 58%. The sensitivity for the retroperitoneum dropped, owing to an intrarenal tumor and an extraperitoneal rectal tear in the small sample of inhospital deaths. The specificity of laparoscopic autopsy reached 94%.


CONCLUSIONS
Laparoscopic autopsy is accurate and easy to perform. It is highly sensitive for intra-abdominal abnormalities, especially in trauma victims. Laparoscopic autopsy is minimally invasive and not disfiguring, rendering it easier to accept among mourning families. It should be strongly considered when consent for a conventional autopsy is lacking.