BACKGROUND/AIMS: The use of diagnostic laparoscopy has declined because of the trend to prefer the less invasive radiological procedure. However, it is still useful in the evaluation and diagnosis of focal and diffuse liver diseases, primary and metastatic liver tumors, and peritoneal diseases. The aim of this study was to reevaluate the clinical role and diagnostic accuracy of laparoscopy. METHODS: We retrospectively reviewed the records of 2185 laparoscopies performed at St. Mary' s Hospital from 1975 to 1997. RESULTS: The most common clinical indication for laparoscopy has been changed from the diagnosis of liver tumors to the diagnosis of chronic parenchymal liver diseases since 1990. The diagnosis was confirmed in 96% of the cases by laparoscopy. The sensitivity and specificity of laparoscopic diagnosis were 97.2% and 86.7%, respectively in chronic hepatitis, 97.6% and 85.7% in liver cirrhosis, 97.3% and 90.2% in hepatocellular carcinoma, 84.4% and 70.0% in metastatic live cancer, 96.8% and 88.9% in tuberculous peritonitis, and 92.3% and 100% in carcinoma peritonei. The complication rate of laparoscopy was 1.7%. Two patients (0.1%) died of massive bleeding from the biopsy site of hepatic tumor. CONCLUSIONS: Diagnostic laparoscopy is a safe and accurate method for evaluating the chronic liver parenchymal diseases and unexplained ascites.