The role of diagnostic laparoscopy for trauma at a high-volume level one center

Abstract

Background The role of minimally invasive surgery in trauma has continued to evolve over the past 20 years. Diagnostic laparoscopy (DL) has become increasingly utilized for the diagnosis and management of both blunt and penetrating injuries. Objective While the safety and feasibility of laparoscopy has been established for penetrating thoracoabdominal trauma, it remains a controversial tool for other injury patterns due to the concern for complications and missed injuries. We sought to examine the role of laparoscopy for the initial management of traumatic injuries at our urban Level 1 trauma center. Methods All trauma patients who underwent DL for blunt or penetrating trauma between 2009 and 2018 were retrospectively reviewed. Demographic data, indications for DL, injuries identified, rate of conversion to open surgery, and outcomes were evaluated. Results A total of 316 patients were included in the cohort. The mean age was 34.9 years old (± 13.7), mean GCS 14 (± 3), and median ISS 10 (4-18). A total of 110/316 patients (35%) sustained blunt injury and 206/316 patients (65%) sustained penetrating injury. Indications for DL included evaluation for peritoneal violation (152/316, 48%), free fluid without evidence of solid organ injury (52/316, 16%), evaluation of bowel injury (42/316, 13%), and evaluation for diaphragmatic injury (35/316, 11%). Of all DLs, 178/316 (56%) were negative for injury requiring intervention, which was 58% of blunt cases and 55% of penetrating cases. There were no missed injuries noted. Average hospital length of stay was significantly shorter for patients that underwent DL vs conversion to open exploration (2.2 days vs. 4.5 days, p < 0.05). Conclusion In this single institution, retrospective study, the high volume of cases appears to show that DL is a reliable tool for detecting injury and avoiding potential negative or non-therapeutic laparotomies. However, when injuries were present, the high rate of conversion to open exploration suggests that its utility for therapeutic intervention warrants further study.

Diagnostic methods and surgical treatment of patients with thoracoabdominal traumas (review of the literature)

“…According Koganti the role of minimally invasive surgery in trauma, in particularly diagnostic laparoscopy, has become increasingly essential and utilized for both blunt and penetrating injuries. Diagnostic laparoscopy can avoid potential negative or non-therapeutic laparotomies [ 18 ]. In the case of thoracoabdominal injuries or their suspicion, video-laparoscopy is performed only after video-thoracoscopy, suturing of the diaphragm wound and adequate drainage of the pleural cavities.…”

Emergency laparoscopic surgery in the elderly and frail patient

“…Percentages of patients who may avoid an open laparotomy range from 30 to 65%, and 50% of the septic patients with a bedside laparoscopy diagnosis are followed by a causal therapeutic intervention [13].…”

Current status and safety of laparoscopic surgery for patients with blunt abdominal trauma: A multicenter study using the Japan Trauma Data Bank

“…The indications for surgical treatment of blunt abdominal trauma include peritonitis due to gastrointestinal perforation and intra‐abdominal hemorrhage, among others. Despite the advances in diagnostic modalities, accurate diagnosis of intraperitoneal injuries remains difficult, 1 and the accuracy of diagnosis of gastrointestinal perforation with multidetector computed tomography is 82%–90% 2 . Therefore, direct observation is necessary when the diagnosis is uncertain and a treatment plan cannot be determined.…”