Optimizing peritoneoscopic visualization of the liver utilizing a double telescope technique

Accurate detection of metastases to the liver is necessary for staging intra-abdominal malignant growths, and precise quantitation of the number and size of metastases is required for monitoring therapy. A great majority of liver metastases occur on the surface of the liver, so that accurate diagnosis may result from more complete visualization of the hepatic surface. A peritoneoscopic technique which optimizes hepatic inspection differs from previous techniques in that two peritoneoscopes are used. The upper abdominal telescope visualizes the superior surface of both lobes of the liver back to the triangular ligament. A telescope inserted at the umbilicus permits visualization of the inferior surface of the liver while the other telescope elevates the edge of the liver.