Peritoneoscopy as an aid in intravenous injection of indocyanine green (ICG) was clinically evaluated. Hepatic parenchyma was stained after intravenous injection of ICG, while interstitial connective tissue, fatty deposition and hepatoma tissue were not. Regenerative hepatic cell mass including dark reddish patchy marking (Shimada's code No. 7) and semispherical areas of regeneration or nodules (Shimada's code No. 8) was well stained and clearly contrasted. There were some cases of chronic active hepatitis, in which liver surface showed spotty staining at sites expected to become regenerative nodules in the future, in contrast to being judged as "no abnormal findings" peritoneoscopically. On the other hand, periportal reddish marking (Shimada's code No. 4) representing piecemeal or bridging hepatic cell necrosis was not stained.

Two cases of histologically confirmed pancreatic cancer are reported. Histological diagnosis was obtained after pancreatic biopsy was carried out under visual control in conjunction with laparoscopy using pancreatic biopsy forceps designed by us. In Case 1, localized swelling of the pancreas was observed on abdominal ultrasonography (US) and computer tomography (CT) scan, and interruption of the main pancreatic duct was demonstrated by endoscopic retrograde cholangiopancreatography (ERCP). In Case 2, a pancreatic tumor was detected by abdominal US and CT scan, but ERCP findings were only those of chronic pancreatitis.

The role of laparoscopy in the diagnosis of gallbladder cancer was evaluated. Fifeen patients who were suspected of having gallbladder cancer, following physical examination, laboratory tests, and imaging techniques, received laparoscopy at our clinic, and the laparoscopic findings and histologies were analyzed. Five patients in whom the gallbladder was observed were laparoscopicallv confirmed as having gallbladder cancer, and in 2 of these cases metastases to the liver were observed. Among the 10 patients in whom the gallbladder could not be observed, metastases to the liver and the peritoneum were observed in 6 and 3 cases, respectively. I n 3 cases neither the gallbladder nor metastases to other tiisceral organs could be observed. Thus, the qualitative rate of laparoscopic diagnosis was 80% (12115 cases). Five cases (42%) among the 12 cases in which laparoscopy suggested gallbladder cancer, were histologically confirmed after biopsy specimens were obtained. Only one of these cases was diagnosed by direct forceps biopsy of the gallbladder wall.