[The diagnostic approach in hepatic lesions--the role and place of laparoscopy with laparoscopic echography]

The study is designed to cases the potentials of laparoscopy with laparoscopic echography, and the role they play in the diagnostic algorithm, with the purpose to develop an optimal therapeutic approach to hepatic lesions. Laparoscope R. Wolf and 7.5 MHz linear transducer, obtained from the Aloka Company are employed in work. A total of 303 patients presenting primary and metastatic carcinoma of liver (58 and 145, respectively), cholangiocarcinoma (11), hemangioma(28), adenomatous hyperplasia (38) and other lesions (23) are studied. Morphologic verification of the diagnosis is done in over one third of cases. In 30 to 40 per cent of the series reviewed laparoscopic echography supplements the laparoscopic finding depending on the type of lesion. Without pretending to create a diagnostic algorithm in individual hepatic lesions, abiding to the following diagnostic approach is strongly recommended: stage one--echography (a noninvasive, not irradiating, cheap, readily accessible and often resolving method), stage two--noninvasive, stage three--invasive, stage four--preoperative or final (laparoscopy plus laparoscopic echography). In the event of properly established indications, the invasive methods of study (thin-needle biopsy under ultrasonographic control plus laparoscopy) may be considered as a second stage, without any need to apply the complete spectrum of examination accessible. Not infrequently, laparoscopy with laparoscopic ultrasonography play a crucial role in diagnosing liver lesions, exact determination of the stage and resectability of the neoplastic process, planning and shortening the duration of operation with simultaneous identification of intractable patients.