BACKGROUND Laparoscopy is an old technique that is frequently used by gastroenterologists in America and Germany. With modern equipment it is now possible to perform this technique under local anaesthesia. OBJECTIVE To evaluate the usefulness and safety of laparoscopic liver biopsy. METHODS Liver biopsy was routinely performed by laparoscopy under local anaesthetic and sedation. A standard 5 mm laparoscope was used and a pneumoperitoneum induced with nitrous oxide. RESULTS Two hundred consecutive patients were laparoscoped and underwent liver biopsy. In five patients the liver could not be visualised due to adhesions. Two patients had bleeds related to the procedure. Twenty-five patients had malignancy diagnosed by guided biopsy. Eight of these had been missed by ultrasound prior to laparoscopy. Cirrhosis was diagnosed laparoscopically in 72 patients. Histology was unable to confirm this diagnosis in four patients. CONCLUSIONS Laparoscopy can be performed safely and comfortably on patients with local anaesthetic and sedation. The visualisation of the liver can add valuable information to liver biopsy.