title: Staging of abdominal cancer by local anesthesia outpatient laparoscopy.
abstract: OBJECTIVE
  Our aim was to review the results of one trocar staging laparoscopies performed under local anesthesia in out patients with intra-abdominal cancer.
  
  
  METHODS
  Two hundred fifteen patients with intra-abdominal cancer (predominantly esophagogastric and pancreatohepatobiliary) underwent one trocar staging laparoscopy on lidocain infiltration anesthesia under conscious sedation. In 43 patients computed tomography (CT) or ultrasonography (US) had raised a suspicion of hepatic metastases, but percutaneous needle biopsy had failed to confirm it; 172 patients had negative CT or US. Peritoneum and liver were examined and biopsies were taken under direct laparoscopic control.
  
  
  RESULTS
  Fourteen patients (7%) received narcotics during the 2-6 hour observation. Mortality was zero. Complications occurred in 5 patients (2%): 1 small bowel perforation (operated), 1 bleeding from the abdominal wall, 1 acute atrial fibrillation, and 2 wound infections. In 79 patients histology demonstrated hepatic or peritoneal metastases. Out of 136 patients 123 were operated in whom laparoscopy did not demonstrate metastases. Thirty-eight of these were unresectable at laparotomy: Five patients (4%) had peritoneal or liver metastases and 33 (27%) proved locally inoperable. The sensitivity of laparoscopy to ascertain peritoneal or liver metastases was 94%.
  
  
  CONCLUSIONS
  We conclude that one trocar local anesthesia outpatient laparoscopy is a fairly safe and effective method to detect peritoneal and liver metastases in abdominal cancer.
authors.affiliation: Department of Surgery, Tampere University Hospital, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Sand
authors.forename: K
authors.initials: K
authors.lastname: Marnela
authors.forename: I
authors.initials: I
authors.lastname: Airo
authors.forename: I
authors.initials: I
authors.lastname: Nordback
mesh_terms: D000008:Abdominal Neoplasms / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001706:Biopsy / Q000379:methods; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010044:Outpatient Clinics, Hospital; D010534:Peritoneal Neoplasms / Q000556:secondary; D012189:Retrospective Studies