To the Editor.–Blind percutaneous liver biopsy has been a widely accepted technique to aid in the diagnosis of primary and metastatic neoplastic disease in the liver. The results, however, have shown varying degrees of success. The addition of liver scanning and of the more sophisticated techniques of computed tomographic scanning and ultrasonography have increased accuracy. Still, there are many patients, particularly those with minimal hepatomegaly, mild changes in results of liver function tests, and with radionuclear scans that show limited neoplastic involvement, whose conditions are difficult or impossible to assess with closed-biopsy techniques. These patients will benefit from guided liver biopsy performed under laparoscopic control.
Although large parts of the liver are not visible through the laparoscope, the results of a recent series of directed biopsies under laparoscopic control showed a better than 90% accuracy in the diagnosis of interhepatic malignancy.1,2
Laparoscopy can be performed without difficulty under