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Jastaniah A, Grushka J. The Role of Minimally Invasive Surgeries in Trauma. Surg Clin North Am 2024; 104:437-449. [PMID: 38453312 DOI: 10.1016/j.suc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
This article delves into the role of minimally invasive surgeries in trauma, specifically laparoscopy and video-assisted thoracic surgery (VATS). It discusses the benefits of laparoscopy over traditional laparotomy, including its accuracy in detecting peritoneal violation and intraperitoneal injuries caused by penetrating trauma. The article also explores the use of laparoscopy as an adjunct to nonoperative management of abdominal injuries and in cases of blunt trauma with unclear abdominal injuries. Furthermore, it highlights the benefits of VATS in diagnosing and treating thoracic injuries, such as traumatic diaphragmatic injuries, retained hematomas, and persistent pneumothorax.
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Affiliation(s)
- Atif Jastaniah
- Division of General Surgery, Department of Surgery, McGill University, 1650 Cedar Avenue, L9-521, Montreal, QC H3G1A4, Canada.
| | - Jeremey Grushka
- Division of General Surgery, Department of Surgery, McGill University, 1650 Cedar Avenue, L9-521, Montreal, QC H3G1A4, Canada
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Elkbuli A, Andrade R, Ngatuvai M, Khan A, Liu H, Bilski T, Ang D. Assessment of Outcomes in Laparotomy vs Laparoscopy: A Propensity Score Matched Analysis of Patients Sustaining Single Penetrating Left Upper Quadrant Injury. Am Surg 2023; 89:5282-5291. [PMID: 36526271 DOI: 10.1177/00031348221146969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND We aim to compare outcomes between laparotomy and laparoscopy in trauma patients with single penetrating left upper quadrant injuries. METHODS Using a 1:1 propensity score match, a retrospective study was conducted utilizing data from the ACS-TQP-PUF between 2016 and 2019. Adults sustaining a single penetrating left upper quadrant injury who received either a laparotomy or laparoscopy were included for analysis. The primary outcome was inpatient mortality. Secondary outcomes included ICU-LOS, H-LOS, and complication rates. Multivariable regression and reliability adjustments were performed to control for confounding. RESULTS 486 patients receiving laparotomy were matched to 486 patients receiving laparoscopy. No differences in inpatient mortality (1.2% vs 2.9%, aOR: 2.92, 95% CI: .32, 26.31); however, patients undergoing laparotomy experienced higher complication rates (7.0% vs 1.2%, aOR: 9.61, 95% CI: 1.94, 47.48), pRBC transfusions (21.8% vs 6.4%, aOR: 3.19, 95% CI: 1.66, 6.13), and H-LOS (Mean ± SD: 8.1 ± 9.8 vs 3.9 ± 4.0, P = .0002). Lower ISS (1 - 15) undergoing laparotomy had more complications (4.3% vs .7%, aOR: 13.52, 95% CI: 1.39, 131.69), pRBC transfusions (13.9% vs 4.9%, aOR: 3.21, 95% CI: 1.53, 6.75), and H-LOS (Mean ± SD: 6.7 ± 7.1 vs 3.6 ± 3.2, P < .0001). There were no differences in mortality among patients with a lower ISS (1.5% vs .4%, aOR: 77.2, 95% CI: (<.001, >999). CONCLUSIONS Laparotomy is associated with increased rates of complications for single penetrating LUQ trauma. For patients with low ISS, laparoscopy is associated with better outcomes without increase in mortality.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| | - Ryan Andrade
- School of Osteopathic Medicine, A.T. Still University, Mesa, AZ, USA
| | - Micah Ngatuvai
- Dr Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Areeba Khan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Huazhi Liu
- Department of Surgery, Division of Trauma and Surgical Critical Care, Ocala Regional Medical Center, Ocala, FL, USA
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| | - Darwin Ang
- Department of Surgery, Division of Trauma and Surgical Critical Care, Ocala Regional Medical Center, Ocala, FL, USA
- Department of Surgery, University of South Florida, Tampa, FL, USA
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Menegozzo CAM, Damous SHB, Sabioni GR, Alves PHF, Rasslan R, de Salles Collet E Silva F, Utiyama EM. Could trauma laparoscopy be the standard of care for hemodynamically stable patients? A retrospective analysis of 165 cases. Surg Endosc 2023; 37:6727-6735. [PMID: 37217684 DOI: 10.1007/s00464-023-10121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Trauma laparoscopy may provide a less invasive alternative to laparotomy by providing accurate diagnosis and minimally invasive management of selected trauma patients. The risk of missing injuries during the laparoscopic evaluation still refrains surgeons from using this approach. Our aim was to evaluate feasibility and safety of trauma laparoscopy in selected patients. METHODS We performed a retrospective review of hemodynamically trauma patients who underwent laparoscopic management in a tertiary center in Brazil due to abdominal trauma. Patients were identified by searching through the institutional database. We collected demographic and clinical data, focusing on avoidance of exploratory laparotomy, and missed injury rate, morbidity, and length of stay. Categorical data were analyzed using Chi-square, while numerical comparisons were performed using Mann-Whitney and Kruskal-Wallis test. RESULTS We evaluated 165 cases, of which 9.7% needed conversion to an exploratory laparotomy. One-hundred and twenty-one patients (73%) had at least one intrabdominal injury. Two missed injuries to retroperitoneal organs were identified (1.2%), of which only one was clinically relevant. Three patients died (1.8%), one of which was due to complications from an intestinal injury after conversion. No deaths were related to the laparoscopic approach. CONCLUSION In selected hemodynamically stable trauma patients, the laparoscopic approach is feasible and safe, and reduces the need for exploratory laparotomy and its associated complications.
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Affiliation(s)
- Carlos Augusto Metidieri Menegozzo
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil.
| | - Sérgio Henrique Bastos Damous
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Guilherme Rissato Sabioni
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Pedro Henrique Ferreira Alves
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Roberto Rasslan
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Francisco de Salles Collet E Silva
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Edivaldo Massazo Utiyama
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
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Makhadi S, Lubout M, Moeng MS. Introduction of Laparoscopy in an Urban High-Volume Sub-Saharan Trauma Centre. World J Surg 2023; 47:1657-1661. [PMID: 36995401 DOI: 10.1007/s00268-023-06980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Trauma is a major disease burden in low and middle-income countries like South Africa. Abdominal trauma is one of the leading reasons for emergency surgery. The standard of care for these patients is a laparotomy. In selected trauma patients, laparoscopy has both diagnostic and therapeutic usage. The trauma burden and the number of cases seen in a busy trauma unit make laparoscopy challenging. AIM We wanted to describe our journey with laparoscopy in the management of abdominal trauma in a busy urban trauma unit in Johannesburg, South Africa. METHODS We reviewed all trauma patients who underwent diagnostic laparoscopy (DL) or therapeutic laparoscopy (TL) between 01 January 2017 and 31 October 2020 for blunt and penetrating abdominal trauma. The demographic data, indications for laparoscopy, injuries identified, procedures performed, intraoperative laparoscopic complications, conversion to laparotomy, morbidity, and mortality were evaluated. RESULTS A total of 54 patients who had laparoscopy were included in the study. The median age was 29 years (IQR 25-25). Most injuries were penetrating 85.2% (n = 46/54) and 14.8% blunt trauma. Most patients were males, 94.4% (n = 51/54). Indications for laparoscopy included diaphragm evaluation (40.7%), pneumoperitoneum for evaluation of potential bowel injury (16.7%), free fluid with no evidence of solid organ injury (12.9%) and colostomy (5.5%). There were 8 (14.8%) cases converted to laparotomy. There were no missed injuries or mortality in the study group. CONCLUSION Laparoscopy in selected trauma patients is safe even in a busy trauma unit. It is associated with less morbidity and shortened hospital length of stay.
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Affiliation(s)
- Shumani Makhadi
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa.
| | - Megan Lubout
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
| | - Maeyane S Moeng
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2193, South Africa
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Segalini E, Khan M, Podda M, Gallo G, Morello A, Marziali I, DI Saverio S. The role of laparoscopic splenectomy in traumatic splenic injury: a narrative review. Minerva Surg 2023; 78:76-80. [PMID: 36448883 DOI: 10.23736/s2724-5691.22.09799-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Splenic injuries are one of the commonest occurrences in abdominal trauma. Nonoperative management (NOM) is the treatment of choice in hemodynamically stable patients with low grade injuries in the absence of vascular injury on CT; however, in some cases, NOM can fail and surgery is required. Traditionally, splenectomy is performed via laparotomy but, recently, the use of laparoscopy is rapidly increasing because the numerous advantages it offers for selected trauma patients. EVIDENCE ACQUISITION A systematic review of the literature was performed through Medline for papers on the laparoscopic splenectomy (LS) in trauma patients, published from January 2006 to July 2022. The inclusion criteria were the study population consisted of hemodynamically stable adult patients treated with LS, as primary treatment or in case of complication or failure of NOM. The data extracted included gender, patient age, type of trauma, ISS, indication for LS and if LS was performed primary or secondary to NOM. The considered outcomes were operative time, length of stay, morbidity and mortality. EVIDENCE SYNTHESIS Eight papers were considered suitable for the study and all the articles were retrospective studies and only one of them was multicentered. A total of 202 patients were included in the study and all of these suffered splenic trauma and all patients were hemodynamically stable or responding to fluid resuscitation. Trauma mechanism was blunt in 92.9% of cases and penetrating in 7%. Twenty-one patients underwent LS after failure of angioembolization. Operative time of LS was reported in 6 papers and the mean was 130.7 mins. Length of stay was reported in 7 papers and the mean was 8.12 days. Overall morbidity was 7.7% and the postoperative mortality was cited in 6 articles with an overall percentage of 2.5%. CONCLUSIONS Laparoscopy should be considered a valid alternative to open surgery, in hemodynamically stable patients and when performed by an experienced surgeon, such as the minimally invasive trauma surgeon.
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Affiliation(s)
- Edoardo Segalini
- Department of General and Emergency Surgery, ASST Ospedale Maggiore, Crema, Cremona, Italy
| | | | - Mauro Podda
- Emergency Surgery Unit, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Science, University of Catanzaro, Catanzaro, Italy
| | - Alessia Morello
- Department of Emergency, ASST Ospedale Maggiore, Crema, Cremona, Italy
| | - Irene Marziali
- Department of General Surgery, Madonna del Soccorso Civil Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Salomone DI Saverio
- Department of General Surgery, Madonna del Soccorso Civil Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy -
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Elkbuli A, Newsome K, Fanfan D, Sutherland M, Bilski T, Liu H, Ang D. Laparoscopic Versus Laparotomy Surgical Interventions for Trauma Patients with Single Upper Left Quadrant Penetrating Injuries: Analysis of the American College of Surgeons Trauma Quality Improvement Program Dataset. Am Surg 2022; 88:2182-2193. [PMID: 35592893 DOI: 10.1177/00031348221101510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aim to identify patient cohorts where laparoscopy can be safely utilized with comparable or better outcomes to laparotomy among patients with single penetrating LUQ injuries with a hypothesis that compared to laparotomy, laparoscopy may be associated with equal or improved outcomes of low injury severity patients. METHODS Retrospective review of the ACS-TQP-Participant Use File 2016-2019 dataset. Patients with single LUQ penetrating injuries were included. Primary outcome was risk-adjusted in-hospital mortality. Secondary outcomes included: risk-adjusted complication rates, hospital length-of-stay (H-LOS), and ICU-LOS. Descriptive statistics and multivariable regression with reliability adjustments to account for variations in practice were performed. RESULTS Of 4149 patients analyzed, 3571 (86.1%) underwent laparotomy, 489 (11.8%) underwent laparoscopy, and 89 (2.1%) underwent laparoscopy-to-laparotomy conversion. Adjusted mortality rates were not significantly different among all study cohorts (P > .05). Compared to laparoscopy, adjusted odds of complications were 4.3-fold higher for all patients who underwent laparotomy and 4-fold higher for laparoscopy-to-laparotomy (LtL) patients (P < .05). Diaphragmatic injuries were associated with significantly increased odds of undergoing LtL, whereas sustaining a colonic injury, gastric injury, hepatic injury, or requiring PRBC transfusions were associated with significantly increased odds of undergoing laparotomy (P < .05). H-LOS (days) was significantly longer for patients who underwent laparotomy compared to laparoscopy (3.9 ± 4.0 vs. 10.8 ± 13.4, P < .0001). CONCLUSIONS Laparoscopy may be considered a viable alternative to laparotomy for hemodynamically stable adult patients with single penetrating LUQ injuries of low injury burden validating our hypothesis. Laparoscopy may be less safe for patients with associated diaphragmatic, colonic, or hepatic injuries.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Division of Medical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
| | - Kevin Newsome
- 5450Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Dino Fanfan
- 5450Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Mason Sutherland
- 2814NSU NOVA Southeastern University, Dr. Kiran.C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Division of Medical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
| | - Huazhi Liu
- Department of Surgery, Division of Trauma and Surgical Critical Care, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Darwin Ang
- Department of Surgery, Division of Trauma and Surgical Critical Care, 23703Ocala Regional Medical Center, Ocala, FL, USA
- University of South Florida, Tampa, FL, USA
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Haratian A, Grigorian A, Rajalingam K, Dolich M, Schubl S, Kuza CM, Lekawa M, Nahmias J. Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers. Am Surg 2022:31348211033535. [DOI: 10.1177/00031348211033535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction An American College of Surgeons (ACS) Level-I (L-I) pediatric trauma center demonstrated successful laparoscopy without conversion to laparotomy in ∼65% of trauma cases. Prior reports have demonstrated differences in outcomes based on ACS level of trauma center. We sought to compare laparoscopy use for blunt abdominal trauma at L-I compared to Level-II (L-II) centers. Methods The Pediatric Trauma Quality Improvement Program was queried (2014-2016) for patients ≤16 years old who underwent any abdominal surgery. Bivariate analyses comparing patients undergoing abdominal surgery at ACS L-I and L-II centers were performed. Results 970 patients underwent abdominal surgery with 14% using laparoscopy. Level-I centers had an increased rate of laparoscopy (15.6% vs 9.7%, P = .019 ); however they had a lower mean Injury Severity Score (16.2 vs 18.5, P = .002) compared to L-II centers. Level-I and L-II centers had similar length of stay ventilator days, and SSIs (all P > .05). Conclusion While use of laparoscopy for pediatric trauma remains low, there was increased use at L-I compared to L-II centers with no difference in LOS or SSIs. Future studies are needed to elucidate which pediatric trauma patients benefit from laparoscopic surgery.
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Affiliation(s)
- Aryan Haratian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Karan Rajalingam
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Matthew Dolich
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Sebastian Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Catherine M Kuza
- Department of Anesthesiology, University of Southern California, Los Angeles, CA, USA
| | - Michael Lekawa
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
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Romeo L, Bagolini F, Ferro S, Chiozza M, Marino S, Resta G, Anania G. Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives. Surg Today 2020; 51:1075-1084. [PMID: 33196920 PMCID: PMC8215029 DOI: 10.1007/s00595-020-02177-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Abstract
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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Affiliation(s)
- Luigi Romeo
- Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Francesco Bagolini
- Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Silvia Ferro
- Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Matteo Chiozza
- Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Serafino Marino
- Department of Surgery, Surgery 1 Unit, Sant'Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Giuseppe Resta
- Department of Surgery, Surgery 1 Unit, Sant'Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Gabriele Anania
- Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.,Department of Surgery, Surgery 1 Unit, Sant'Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
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Birindelli A, Podda M, Segalini E, Cripps M, Tonini V, Tugnoli G, Lim RB, Di Saverio S. Is the minimally invasive trauma surgeon the next (r)evolution of trauma surgery? Indications and outcomes of diagnostic and therapeutic trauma laparoscopy in a level 1 trauma centre. Updates Surg 2020; 72:503-512. [PMID: 32219731 DOI: 10.1007/s13304-020-00739-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 03/04/2020] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the trend in use, feasibility and safety of laparoscopy in a single level 1 European trauma centre. Laparoscopy in abdominal trauma is gaining acceptance as a diagnostic and a therapeutic tool as it reduces surgical invasiveness and may reduce post-operative morbidity. All trauma patients who underwent a laparoscopic procedure between January 2013 and December 2017 were retrospectively analysed. A sub-analysis of isolated abdominal trauma was also performed. There has been a significant increase in the use of this technique in the considered time period. A total of 40 patients were included in the study: 17 diagnostic laparoscopies and overall 32 therapeutic laparoscopies. Conversion rate was 15%. All patients were hemodynamically stable. The majority of patients were younger than 60 years, with an ASA score of I-II and sustained a blunt trauma. Mean ISS score was 17. Colon and diaphragm were the most commonly laparoscopically diagnosed injuries, while splenectomy was the most common operation. The average operating time was 106 min. There were no missed injuries, no SSI, no re-interventions and no mortality related to the surgical procedure. The average length of stay was 14 days. No significant difference was found in the isolated abdominal trauma group. Laparoscopy is an emergent safe and effective technique for both diagnostic and therapeutic purposes in selected stable abdominal penetrating or blunt trauma patients. However, these results need to be put in relation with the level of the centre and the expertise of the surgeon.
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Affiliation(s)
- Arianna Birindelli
- Department of Surgery, University of Bologna, Bologna, Italy.,General, Trauma and Emergency Surgery Unit, Bufalini Hospital, Cesena, Italy
| | - Mauro Podda
- Department of General, Emergency and Minimally Invasive Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Michael Cripps
- Division of Burn/Trauma/Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Valeria Tonini
- Department of Surgery, University of Bologna, Bologna, Italy
| | - Gregorio Tugnoli
- Trauma Surgery Unit, Emergency Department, Maggiore Hospital, Bologna, Italy
| | - Robert B Lim
- Department of Surgery, Tripler Army Medical Center, Tripler, Honolulu, HI, USA
| | - Salomone Di Saverio
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK. .,Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy.
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10
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Shamim AA, Zeineddin S, Zeineddin A, Olufajo OA, Mathelier GO, Cornwell Iii EE, Fullum T, Tran D. Are we doing too many non-therapeutic laparotomies in trauma? An analysis of the National Trauma Data Bank. Surg Endosc 2019; 34:4072-4078. [PMID: 31605217 DOI: 10.1007/s00464-019-07169-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Exploratory laparotomy (EL) has been the definitive diagnostic and therapeutic modality for operative abdominal trauma in the US. Recently, many trauma centers have started using diagnostic laparoscopy (DL) in stable trauma patients in an effort to reduce the incidence of non-therapeutic laparotomy (NL). We aim to evaluate the incidence of NL in the trauma population in the US and compare the outcomes between DL and NL. METHODS Using ICD-9 codes, the National Trauma Data Bank (2010-2015) was queried for patients undergoing any abdominal surgical intervention. Patients were divided into two groups: diagnostic laparoscopy (DL) and exploratory laparotomy (EL). Hemodynamically unstable patients on arrival and patients with abbreviated injury score (AIS) > 3 were excluded. Patients in EL group without any codes for gastrointestinal, diaphragmatic, hepatic, splenic, vascular, or urological procedures were considered to have undergone NL. After excluding patients who were converted to open from the DL group, multivariate regression models were used to analyze the outcomes of DL vs NL group with respect to mortality, length of stay, and complications. RESULTS A total of 3197 patients underwent NL vs 1323 patients who underwent DL. Compared to DL group, the NL group were older (mean age: 35 vs. 31, P < 0.01). Rate of penetrating injury was 77% vs 86% for patients in NL vs DL. On multivariate analysis, NL was associated with increased mortality (OR 4.5, 95% CI 2.1-9.7), higher rate of complications (OR 2.2, 95% CI 1.4-3.3), and a longer hospital stay (OR 2.7, 95% CI 2.1-3.5). NL was also associated with higher rates of pneumonia, VTE, ARDS, and cardiac arrest. CONCLUSION With increasing experience in minimally invasive surgery, DL should be a part of the armamentarium of trauma surgeons. This study supports that in well-selected trauma patients DL has favorable outcomes compared to NL. These findings warrant further investigation.
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Affiliation(s)
- Adeel A Shamim
- Department of Surgery, Howard University Hospital, Washington, DC, USA.
- , Room 4B-17, 2041 Georgia Avenue NW, Washington, DC, 20060, USA.
| | | | - Ahmad Zeineddin
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Olubode A Olufajo
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | | | | | - Terrence Fullum
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Daniel Tran
- Department of Surgery, Howard University Hospital, Washington, DC, USA
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11
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Cocco AM, Bhagvan S, Bouffler C, Hsu J. Diagnostic laparoscopy in penetrating abdominal trauma. ANZ J Surg 2019; 89:353-356. [DOI: 10.1111/ans.15140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Clare Bouffler
- Department of SurgeryWestmead Hospital Sydney New South Wales Australia
| | - Jeremy Hsu
- Department of TraumaWestmead Hospital, The University of Sydney Sydney New South Wales Australia
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12
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Koto MZ, Matsevych OY, Mosai F, Patel S, Aldous C, Balabyeki M. Laparoscopy for blunt abdominal trauma: a challenging endeavor. Scand J Surg 2018; 108:273-279. [PMID: 30522416 DOI: 10.1177/1457496918816927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score values and higher morbidity and mortality, as compared with patients with penetrating abdominal trauma. The aim of this study was to investigate the role of laparoscopy in the management of blunt abdominal trauma patients and to highlight related challenges. MATERIAL AND METHODS Over a 4-year period, patients managed laparoscopically for blunt abdominal trauma were retrospectively analyzed. Perioperative details, indications for laparoscopy and conversion, complications, and length of hospital stay were discussed. RESULTS A total of 35 stable patients underwent laparoscopy. The mean Injury Severity Score was 12 (4-38). Therapeutic laparoscopy was performed in 15 (56%) and diagnostic in 12 (44%) patients. Eight (23%) patients were converted to therapeutic laparotomy. Intraoperative bleeding, complex injuries, visualization problem, and equipment failure necessitated conversion. Three (30%) patients with negative computed tomography scan had therapeutic laparoscopy for mesenteric injuries. There were no missed injuries. The mean length of hospital stay was 11 days in both groups. CONCLUSION Laparoscopy for stable patients is feasible and safe. Multiple injuries make laparoscopy more difficult, and advanced laparoscopic skills are required. The conversion rate is high; however, the non-therapeutic laparotomies were completely eliminated in this study.
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Affiliation(s)
- M Z Koto
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - O Y Matsevych
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - F Mosai
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - S Patel
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - C Aldous
- University of KwaZulu-Natal, Durban, South Africa
| | - M Balabyeki
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Bain K, Meytes V, Chang GC, Timoney MF. Laparoscopy in penetrating abdominal trauma is a safe and effective alternative to laparotomy. Surg Endosc 2018; 33:1618-1625. [DOI: 10.1007/s00464-018-6436-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 09/05/2018] [Indexed: 11/28/2022]
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