Laparoscopic approaches to abdominal malignancy

The use of laparoscopy for diagnosis and staging of intra-abdominal malignancies is not an exclusive procedure. It is another modality in the armamentarium of caring for the patient. The selection of the appropriate patients is discussed in detail and must include a determination of the long-range plans for intervention. The technical issues include problems of previous abdominal surgery, adhesions, ability to tolerate general endotracheal anesthesia, and ability to properly position the patient for an adequate examination. The endoscopic surgeon must be able to differentiate between the benign and malignant process during endoscopic examination and must be skilled in obtaining appropriate biopsies. In the staging of lymphoma, laparoscopy has virtually replaced the open celiotomy technique. Laparoscopic removal of appropriate lymph nodes is essential. The role of laparoscopy in a second-look operation is discussed as well as contraindications and complications of the procedure.