Trauma laparoscopy and the six w's: Why, where, who, when, what, and how?

Saverio, Salomone Di; Birindelli, Arianna; Podda, Mauro; Segalini, Edoardo; Piccinini, Alice; Coniglio, Carlo; Frattini, Cristina; Tugnoli, Gregorio

doi:10.1097/ta.0000000000002130

Cited by 36 publications

(20 citation statements)

References 78 publications

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“…During this investigation, the patient became increasingly unstable with blood pressure 75/45 mmHg and cardiac frequency > 100 pulse rate per minute and mildly anxious, which is why the patient, in accordance with the literature, had an emergency (rather than laparoscopic) laparotomy within 2 hours of presentation. This revealed 2 L of free blood in the peritoneal cavity and a bulky blood clot attached to the lower pole of the broken spleen [ 7 ].…”

Section: Case Presentationmentioning

confidence: 99%

Atraumatic Splenic Rupture in a SARS-CoV-2 Patient: Case Report and Review of Literature

Agus

Ferrara

Bianco

et al. 2021

Case Reports in Surgery

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Splenic rupture in the absence of trauma or previously diagnosed disease is rare. Due to the delay of diagnosis and treatment, this is a potentially life-threatening condition. We report a case of atraumatic splenic rupture in a SARS-CoV-2 patient. This report is of particular interest as it first identifies SARS-CoV-2 infection as a possible cause of spontaneous rupture of the spleen. A 46-year-old Caucasian woman presented at the emergency department pale and sweaty, complaining of syncopal episodes, tachycardia, hypotension, diarrhea, intense abdominal pain, diffuse arthromyalgia, and fever from the day before. RT-PCR was positive for SARS-CoV-2 infection. CT scan demonstrated extensive hemoperitoneum due to rupture of the splenic capsule. The patient required an emergency open splenectomy because of an unresponsive hemorrhagic shock. At the end of the surgery, the patient was relocated to a COVID-19 dedicated facility. COVID-19 is a new disease of which all manifestations are not yet known. Inpatients affected by SARS-CoV-2 infection with abdominal pain and spontaneous splenic rupture should be considered to avoid a delayed diagnosis.

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Section: Case Presentationmentioning

confidence: 99%

Atraumatic Splenic Rupture in a SARS-CoV-2 Patient: Case Report and Review of Literature

Agus

Ferrara

Bianco

et al. 2021

Case Reports in Surgery

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“…Thus, trauma surgeons need a great deal of experience and advanced skill. The possibility of open conversion may be high in severe bleeding and retroperitoneal organ injury [ 1 ]. Computed tomography (CT) or focused assessment with sonography for trauma (FAST) may help to decide to attempt therapeutic laparoscopy [ 1 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…The possibility of open conversion may be high in severe bleeding and retroperitoneal organ injury [ 1 ]. Computed tomography (CT) or focused assessment with sonography for trauma (FAST) may help to decide to attempt therapeutic laparoscopy [ 1 , 34 ]. If there are no specific findings on physical examination and there is no severe bleeding in CT or FAST, therapeutic laparoscopy may be attempted.…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy and Safety of Laparoscopy for Blunt Abdominal Trauma: A Systematic Review and Meta-Analysis

Park

et al. 2021

JCM

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The efficacy and safety of laparoscopy for blunt trauma remain controversial. This systemic review and meta-analysis aimed to evaluate the usefulness of laparoscopy in blunt trauma. The PubMed, EMBASE, and Cochrane databases were searched up to 23 February 2021. Meta-analyses were performed using odds ratios (ORs), standardized mean differences (SMDs), and overall proportions. Overall, 19 studies with a total of 1520 patients were included. All patients were hemodynamically stable. In the laparoscopy group, meta-analysis showed lesser blood loss (SMD −0.28, 95% confidence interval (CI) −0.51 to −0.05, I2 = 62%) and shorter hospital stay (SMD −0.67, 95% CI −0.90 to −0.43, I2 = 47%) compared with the laparotomy group. Pooled prevalence of missed injury (0.003 (95% CI 0 to 0.023), I2 = 0%), nontherapeutic laparotomy (0.004 (95% CI 0.001 to 0.026), I2 = 0%), and mortality (0.021 (95% CI 0.010 to 0.043), I2 = 0%) were very low in blunt trauma. In subgroup analysis, recently published studies (2011–present) showed lesser conversion rate (0.115 (95% CI 0.067 to 0.190) vs. 0.391 (95% CI 0.247 to 0.556), test for subgroup difference: p < 0.01). This meta-analysis suggests that laparoscopy is a safe and feasible option in hemodynamic stable patients with blunt abdominal trauma.

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“…Many studies have explored this in recent years [ 4 ], and shown the advantages of this approach in hemodynamically stable patients. In fact, while trauma patients can benefit from the same advantages of laparoscopy for elective surgery (less abdominal pain, less wound infections, and faster recovery), the risks of both diagnostic and therapeutic laparoscopic surgery for trauma, such as missed injuries or the need for conversion, are limited if minimally invasive surgery is performed by experienced surgeons [ 54 , 55 ].…”

Section: Current Indications For Laparoscopic Splenectomy For Splenic Traumatic Injuriesmentioning

confidence: 99%

Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives

et al. 2020

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The spleen is one of the organs most commonly injured by blunt abdominal trauma. It plays an important role in immune response to infections, especially those sustained by encapsulated bacteria. Nonoperative management (NOM), comprising clinical and radiological observation with or without angioembolization, is the treatment of choice for traumatic splenic injury in patients who are hemodynamically stable. However, this strategy carries a risk of failure, especially for high-grade injuries. No clear predictors of failure have been identified, but minimally invasive surgery for splenic injury is gaining popularity. Laparoscopic surgery has been proposed as an alternative to open surgery for hemodynamically stable patients who require surgery, such as after failed NOM. We reviewed research articles on laparoscopic surgery for hemodynamically stable patients with splenic trauma to explore the current knowledge about this topic. After presenting an overview of the treatments for splenic trauma and the immunological function of the spleen, we try to identify the future indications for laparoscopic surgery in the era of NOM.

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Trauma laparoscopy and the six w's: Why, where, who, when, what, and how?

Cited by 36 publications

References 78 publications

Atraumatic Splenic Rupture in a SARS-CoV-2 Patient: Case Report and Review of Literature

Atraumatic Splenic Rupture in a SARS-CoV-2 Patient: Case Report and Review of Literature

The Efficacy and Safety of Laparoscopy for Blunt Abdominal Trauma: A Systematic Review and Meta-Analysis

Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives

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