Laparoscopic autopsies.

ABSTRACT

BACKGROUND: In recent years, autopsy consent rates have fallen nationwide. In our institution they have declined from 15% to 7% in 10 years. We perceived that family reluctance to grant permission for autopsy was related to the invasiveness of the open procedure, so we began to do autopsies by needle biopsy, with an increase in consents to 25% during the first year. However, the procedure is inherently inaccurate, so we recently have introduced minimally invasive laparoscopic autopsy. METHODS: From July through October 1999, needle biopsy was performed on 25 patients who died at our institution, which was followed by laparoscopic evaluation. Consent for full conventional autopsy had been granted in nine cases, and these then were performed. Data from these autopsies were compared with those from the laparoscopic procedures. RESULTS: Of the patients for whom consent was obtained for open autopsy, there was complete agreement as to cause of death between the laparoscopic and conventional procedures. In one case, a liver hemangioma was missed by laparoscopy, and in two other cases, colon polyps were not discovered. Biopsies of internal organs were accurately performed on the pancreas, kidneys, and adrenals, all of which had been troublesome for needle biopsy alone. CONCLUSIONS: Laparoscopic autopsy is much more acceptable to the families of patients than the conventional form, resulting in a higher consent rate. On the basis of our study group, this procedure provides accurate data concerning the cause of death. In addition, performing these autopsies gives surgical residents invaluable training in laparoscopic skills.