Staging laparoscopy has been proposed for liver malignancies to identify missed hepatic or extrahepatic lesions, in order to decrease the incidence of non-therapeutic laparotomy and guide the appropriate treatment. The application of laparoscopic approach has not been fully developed for liver surgery due to the presumed technical difficulties and concern about its feasibility. The aim of this study was to report our experience of laparoscopy ± laparoscopic intraoperative ultrasonography (IOUS) in the management of liver tumours.From 02/2000 to 11/2006, 18 males and 34 females of a mean age of 50.4±14.3 years (range 20-76) underwent laparoscopic exploration for hepatic focal lesions. Preoperative exploration (US n=52, CT-scan n=46 and MRI n=44, Sonovue US n=6, PET n=4, Octreoscan n=1) detected 107 lesions (diameter from 5 to 140 mm), 39 unilobar and 13 bilobar. A matched group of open resection was studied for comparison as an indirect way to test the necessity for preoperative laparoscopic exploration: 25 males and 12 females of a mean age of 63 ± 13 years (range 27-79) in the period from 05/2005 to 12/2007. Laparoscopic exploration discovered 10 new lesions in 7 patients (13.4%): 7 by direct exploration and 3 with IOUS. Laparoscopic hepatic resection was performed in 43 cases (82.6%): 2 left hepatectomies, 9 left lateral segmentectomies, 6 segmentectomies and 26 non-anatomical resections. Six had laparoscopic liver biopsies. Three patients had local ablation (2 RFA, 1 cryotherapy). Four had conversion: 2 for haemorrhage, 1 for splenic injury and 1 for technical difficulty. Median surgical time was 1h57. One cardiac patient died from heart falure in early post-operative period, another developed biliary fistula treated by radiological stent, and 3 patients had medical complications. Mean hospital stay was 6±2.8 days (range 2-14). Recurrence occurred in 6 cases: 4 HCC, 1 metastasis and 1 adenoma (3 of them following ablation). Results of the open group as well as the laparoscopic one proved the high accuracy of preoperative imaging. In this study, laparoscopic exploration did not modify the planned treatment but helped optimize the surgical procedure. Besides, laparoscopic hepatic surgery was safe and feasible in well selected patients.