1. Subaquatic laparoscopy for staging of intraabdominal malignancy
Eddie K Abdalla, MD, Carlton C Barnett, MD, Peter W.T Pisters, MD, FACS, Karen R Cleary, MD, Douglas B Evans, MD, FACS, Barry W Feig, MD, FACS, Paul F Mansfield, MD, FACS 
Journal of the American College of Surgeons 
Volume 196, Issue 1, Pages (January 2003)
DOI: /S (02)

2. Figure 1
Bubbles under meniscus. Dashed arrows demonstrate air bubbles at the undersurface of saline viewed from below the surface of saline instilled during laparoscopy. This is a view of the diaphragm above the liver. Note the clear picture without any mechanical retraction.
Journal of the American College of Surgeons  , DOI: ( /S (02) )

3. Figure 2
Pretreatment staging computed tomography. Upper panel: Arterial phase of spiral computed tomograph revealing endobiliary stent (arrow head), hypodense uncinate tumor adjacent to superior mesenteric vein (dashed arrow) and free plane around superior mesenteric artery (solid arrow). Lower panel: No hepatic metastases are identified, but small posterior adhesion is seen (arrow).
Journal of the American College of Surgeons  , DOI: ( /S (02) )

4. Figure 3
Subaquatic laparoscopic view of adhesions and metastasis. Upper panel: “Under water” view of a fold in the diaphragm (large black arrow) posterior to the liver near an adhesion gently stretched by the saline (small black arrow). A suspicious nodule (white arrow) is found. Bubbles are seen (dashed arrow) floating on the surface of the instilled saline. Lower panel: Further investigation of the area of adhesions reveals a very suspicious nodule (white arrow) with a surrounding array of blood vessels and nearby smaller nodules (black arrows). No mechanical retraction is required because of the clear view afforded by insertion of the laparoscope under saline. Biopsy revealed metastatic adenocarcinoma.
Journal of the American College of Surgeons  , DOI: ( /S (02) )

5. Figure 4
Frozen section photomicrograph. Intraoperative frozen section of the lesion on the retrohepatic diaphragm depicted in Figure 3. Malignant glands are seen in fibrous connective tissue diagnostic of adenocarcinoma, consistent with pancreatic origin. Hematoxylin and eosin stain, original magnification 100×.
Journal of the American College of Surgeons  , DOI: ( /S (02) )