Laparoscopic vs conventional autopsy. A promising perspective
R. Avrahami, S. Watemberg, Y. Hiss and A. A. Deutsch
Department of Surgery B, Belinson Medical Center, Petah Tiqwa, Israel.
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.
