The value of laparoscopic ultrasonography in the staging of cancer of the pancreatic head region was compared prospectively to that of transabdominal ultrasonography. Eighty patients underwent LUS, after ultrasonography had shown normal Doppler findings of portal vessels and no signs of metastatic disease. Presence of hepatic or lymph node metastases and vascular tumor infiltration were evaluated in 74 and 48 patients, respectively. Laparoscopic ultrasonography showed liver metastases in 10 patients (14%). Specificity and positive predictive value for the laparoscopic technique determining vascular ingrowth were 97% and 92%, respectively, versus 89% and 77% by sonography in patients with normal Doppler findings (difference not statistically significant). Laparoscopic ultrasonography has shown improved detection of hepatic metastases compared to sonography, but it still must prove its value, as compared to noninvasive methods, in local staging.