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Minilaparoscopy versus conventional laparoscopy in the diagnosis of hepatic diseases.

BACKGROUND
Minilaparoscopy (ML) is being used increasingly in the diagnosis 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 randomized either to undergo CL (n = 50) or ML (n = 54). CL was performed with a standard Storz laparoscope (Ø 11 mm, Storz GmbH, Tuttlingen, Germany) 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%) patients with simultaneous procurement of biopsy specimens of the liver. In 4 cases, postoperative adhesions prevented sufficient inspection of the liver and in another patient the technique was switched from CL to ML for the same reason. Minor self-limiting bleeding at the biopsy site was observed in 20% of CL and 15% of ML examinations. One patient in each group required surgery for uncontrollable bleeding from the biopsy site. The patients' subjective perception of the examination was comparable in both groups. Compared with CL, ML could be performed in a significantly shorter time (27 vs. 22 min, p < 0.05). Liver cirrhosis diagnosed during laparoscopy was histologically confirmed in 77%, independent of the method of examination. Cirrhosis was diagnosed by histology in 1 of 14 (7%) and 1 of 21 (5%) patients without macroscopic signs of cirrhosis.


CONCLUSIONS
Laparoscopy with a small diameter telescope in the workup of liver disease is comparable in terms of results to CL. Possible advantages of ML are a shorter examination time and a subjective impression of lower degree of invasiveness.