Laparoscopy under sedation is a safe and a well tolerated procedure which can be readily performed in the endoscopy suite. In the investigation of patients with chronic liver disease it is more accurate than histology alone in staging the severity of disease and adds valuable prognostic information. In patients with focal liver disease it has a high degree of sensitivity and this is likely to increase with technological advances, such as sonolaparoscopy. We strongly believe that in many countries diagnostic laparoscopy is an under utilized diagnostic tool which deserves wider incorporation into clinical practice and training programmes.