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Laparoscopic vs Conventional Autopsy: A Promising Perspective

Laparoscopic vs Conventional Autopsy: A Promising Perspective Abstract Objective: To analyze the sensitivity and specificity of laparoscopic autopsy when compared with the ulterior performance of conventional postmortem examination. Design: Consecutive sampling, case-series study. Setting: A general community referral medical center and the local institute of forensic medicine. Participants: A consecutive sample of 25 fresh cadavers (<24 hours old) of victims of vehicle accidents, gunshot wounds, and in-hospital deaths. Interventions: After insufflation with carbon dioxide, laparoscopy of the abdominal cavity and inspection of the retroperitoneal area was accomplished. Following, a conventional postmortem examination was performed and the findings of both procedures were recorded, compared, and analyzed. Main Outcome Measures: Prior to the beginning of the study, it was hypothesized that laparoscopic autopsy would reach an overall sensitivity and specificity of at least 85% and enable accurate inspection of the abdominal cavity and retroperitoneum in the search for the trauma-related cause of death in trauma victims or the cause of death for in-hospital patients. Results: There was a 100% correlation of both procedures in all accidental cases. The sensitivity of laparoscopic autopsy was 93% for intra-abdominal lesions, with an overall sensitivity of 91%. For the retroperitoneal area, the sensitivity was 58%. The sensitivity for the retroperitoneum dropped, owing to an intrarenal tumor and an extraperitoneal rectal tear in the small sample of inhospital deaths. The specificity of laparoscopic autopsy reached 94%. Conclusions: Laparoscopic autopsy is accurate and easy to perform. It is highly sensitive for intra-abdominal abnormalities, especially in trauma victims. Laparoscopic autopsy is minimally invasive and not disfiguring, rendering it easier to accept among mourning families. It should be strongly considered when consent for a conventional autopsy is lacking.(Arch Surg. 1995;130:407-409) References 1. Sosa JL, Sims D, Martin L, Zeppa R. Laparoscopic evaluation of tangential abdominal gunshot wound . Arch Surg . 1992;127:109-110.Crossref 2. Falcone RE, Barnes FE, Hoogeboom JE. Blunt diaphragmatic rupture diagnosed by laparoscopy: report of a case . J Laparoendosc Surg . 1991;1:299-302.Crossref 3. Berci G, Dunkelman D, Michel SL, Sanders G, Wahlstom E, Morgernstern L. Emergency minilaparoscopy in abdominal trauma . Am J Surg . 1983;146:261-265.Crossref 4. Sackier J. Diagnostic laparoscopy in nonmalignant disease . Surg Clin North Am . 1992;72:1033-1043. 5. Braasch JW. Laparoscopic cholecystectomy and other procedures . Arch Surg . 1992:127:887.Crossref 6. Goldsmith MF. Future surgery: minimal invasion . JAMA . 1990:264:2723.Crossref 7. Leape LL, Ramenofsky ML. Laparoscopy for questionable appendicitis: can it reduce the negative appendectomy rate? Ann Surg . 1980;191:410-413.Crossref 8. Deutsch AA, Zelikovsky A, Reiss R. Laparoscopy in the prevention of unnecessary appendectomies: a prospective study . Br J Surg . 1982;69:336-337.Crossref 9. Paterson-Brown S, Eckersley JR, Sim AJ, Dudley HA. Laparoscopy as an adjunct to decision making in the 'acute abdomen.' Br J Surg . 1986;73:1022-1024.Crossref 10. Reiertsen O, Rosseland AR, Hoivik B, Solheim K. Laparoscopy in patients admitted for acute abdominal pain . Acta Chir Scand . 1985;151:521-524. 11. Sugarbaker PH, Sanders JH, Bloom BS, Wilson RE. Preoperative laparoscopy in diagnosis of acute abdominal pain . Lancet . 1975;1:442-445.Crossref 12. Salky B. Diagnostic laparoscopy . Surg Laparosc Endosc . 1993;3:132-134. 13. Nagy AG, James D. Diagnostic laparoscopy . Am J Surg . 1989;157:490-493.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Laparoscopic vs Conventional Autopsy: A Promising Perspective

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1995.01430040069014
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To analyze the sensitivity and specificity of laparoscopic autopsy when compared with the ulterior performance of conventional postmortem examination. Design: Consecutive sampling, case-series study. Setting: A general community referral medical center and the local institute of forensic medicine. Participants: A consecutive sample of 25 fresh cadavers (<24 hours old) of victims of vehicle accidents, gunshot wounds, and in-hospital deaths. Interventions: After insufflation with carbon dioxide, laparoscopy of the abdominal cavity and inspection of the retroperitoneal area was accomplished. Following, a conventional postmortem examination was performed and the findings of both procedures were recorded, compared, and analyzed. Main Outcome Measures: Prior to the beginning of the study, it was hypothesized that laparoscopic autopsy would reach an overall sensitivity and specificity of at least 85% and enable accurate inspection of the abdominal cavity and retroperitoneum in the search for the trauma-related cause of death in trauma victims or the cause of death for in-hospital patients. Results: There was a 100% correlation of both procedures in all accidental cases. The sensitivity of laparoscopic autopsy was 93% for intra-abdominal lesions, with an overall sensitivity of 91%. For the retroperitoneal area, the sensitivity was 58%. The sensitivity for the retroperitoneum dropped, owing to an intrarenal tumor and an extraperitoneal rectal tear in the small sample of inhospital deaths. The specificity of laparoscopic autopsy reached 94%. Conclusions: Laparoscopic autopsy is accurate and easy to perform. It is highly sensitive for intra-abdominal abnormalities, especially in trauma victims. Laparoscopic autopsy is minimally invasive and not disfiguring, rendering it easier to accept among mourning families. It should be strongly considered when consent for a conventional autopsy is lacking.(Arch Surg. 1995;130:407-409) References 1. Sosa JL, Sims D, Martin L, Zeppa R. Laparoscopic evaluation of tangential abdominal gunshot wound . Arch Surg . 1992;127:109-110.Crossref 2. Falcone RE, Barnes FE, Hoogeboom JE. Blunt diaphragmatic rupture diagnosed by laparoscopy: report of a case . J Laparoendosc Surg . 1991;1:299-302.Crossref 3. Berci G, Dunkelman D, Michel SL, Sanders G, Wahlstom E, Morgernstern L. Emergency minilaparoscopy in abdominal trauma . Am J Surg . 1983;146:261-265.Crossref 4. Sackier J. Diagnostic laparoscopy in nonmalignant disease . Surg Clin North Am . 1992;72:1033-1043. 5. Braasch JW. Laparoscopic cholecystectomy and other procedures . Arch Surg . 1992:127:887.Crossref 6. Goldsmith MF. Future surgery: minimal invasion . JAMA . 1990:264:2723.Crossref 7. Leape LL, Ramenofsky ML. Laparoscopy for questionable appendicitis: can it reduce the negative appendectomy rate? Ann Surg . 1980;191:410-413.Crossref 8. Deutsch AA, Zelikovsky A, Reiss R. Laparoscopy in the prevention of unnecessary appendectomies: a prospective study . Br J Surg . 1982;69:336-337.Crossref 9. Paterson-Brown S, Eckersley JR, Sim AJ, Dudley HA. Laparoscopy as an adjunct to decision making in the 'acute abdomen.' Br J Surg . 1986;73:1022-1024.Crossref 10. Reiertsen O, Rosseland AR, Hoivik B, Solheim K. Laparoscopy in patients admitted for acute abdominal pain . Acta Chir Scand . 1985;151:521-524. 11. Sugarbaker PH, Sanders JH, Bloom BS, Wilson RE. Preoperative laparoscopy in diagnosis of acute abdominal pain . Lancet . 1975;1:442-445.Crossref 12. Salky B. Diagnostic laparoscopy . Surg Laparosc Endosc . 1993;3:132-134. 13. Nagy AG, James D. Diagnostic laparoscopy . Am J Surg . 1989;157:490-493.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1995

References