- Systematic inspection
- Inspect all peritoneal surfaces: diaphragm, anterior abdominal wall, omentum, pelvis
- Inspect liver surface:
- Start with left lobe (segments II and III)
- Then move to right lobe (segments V–VIII), including dome using liver retraction and reverse Trendelenburg
- Examine falciform ligament and ligamentum teres
- Assess for lesions: number, location, surface characteristics, capsular retraction, or satellite nodules
- Palpation with instruments can aid assessment if visualisation is unclear
- Intraoperative ultrasound (IOUS)
- Use a laparoscopic ultrasound probe to assess parenchymal lesions
- Helps detect deep or isoechoic lesions not visible on the surface
- Can define relationship to vessels and guide biopsy or resection planning
- Biopsy (if indicated)
- Select lesion or edge of suspicious area
- Use either:
- Tru-Cut core biopsy (preferable for histology)
- Diathermy/snare excision for small nodules
- Ensure haemostasis with pressure, bipolar, or haemostatic agents