Laparoscopy in trauma: An overview of complications and related topics

Abstract

The introduction of laparoscopy has provided trauma surgeons with a valuable diagnostic and, at times, therapeutic option. The minimally invasive nature of laparoscopic surgery, combined with potentially quicker postoperative recovery, simplified wound care, as well as a growing number of viable intraoperative therapeutic modalities, presents an attractive alternative for many traumatologists when managing hemodynamically stable patients with selected penetrating and blunt traumatic abdominal injuries. At the same time, laparoscopy has its own unique complication profile. This article provides an overview of potential complications associated with diagnostic and therapeutic laparoscopy in trauma, focusing on practical aspects of identification and management of laparoscopy-related adverse events.

Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury

“…Trauma laparoscopy is useful in identifying retroperitoneal hematoma. [ 17 ] Either the transperitoneal or retroperitoneal route has been reported as a safe approach in patients with renal cell carcinoma who had undergone partial nephrectomy. [ 18 ] In the present case, the transperitoneal laparoscopic approach was selected, considering the risk of disorientation, which may cause inadvertent injury.…”

Multiple isolated small bowel perforations following blunt abdominal trauma

“…However, other factors must be taken into account, such as patient related factors, surgical team laparoscopy experience and occasional inadequate injury visualization and missed injury. A published overview focused on the practical aspects of the potential complications of laparoscopy in abdominal trauma (ref to Kindel et al) states that when laparoscopy exploration is performed following previous abdominal procedures, there is a 12% rate of failure to achieve pneumoperitoneum, and port placement is more difficult in such patients, with a conversion rate of up to 50% [ 5 , 6 ]. Additionally, they argue that the laparoscopic approach is less diagnostically reliable with sensitivity of only 18% and negative predictive value of 83%, where the diagnostic accuracy is dependent on the surgeon laparoscopy skills [ 6 ].…”

“…A laparoscopic approach in abdominal trauma can decrease the chance of a negative laparotomy and allow a diagnostic and therapeutic option with reduced morbidity [ 5 ]. However, in blunt abdominal trauma the formal indications for minimal invasive approach are not yet established, and several factors related to the patient and surgical team must be taken into account in decision-making process [ 6 ].…”

Transperitoneal laparoscopic nephrectomy in acute Grade 4 renal trauma with literature review and a note on some unusual complications

“…Obvious contraindications are haemodynamic instability, shock, head injury, retinal detachment and coagulopathy. [ 6 ]…”

“…CO 2 -related pneumothorax can occur due to diaphragmatic injury, tearing of diaphragm due to high insufflation pressures and diffusion of gas in retroperitonium that accumulates in pleura. [ 6 ] Chest imaging in diaphragm injuries can be normal. [ 6 ] It may manifest first intraoperatively with a sudden increase in end-tidal CO 2 , decrease in lung compliance and floppy diaphragm.…”