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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Acknowledgements
Antonio Affinita (Radiology Department Maggiore Hospital Bologna, Italy), Carlo Coniglio (Trauma ICU, Maggiore Hospital Bologna, Italy), Fausto Catena (Emergency Surgery Unit, University Hospital, Parma, Italy), Luca Ansaloni (General Surgery Unit, Bufalini Hospital, Cesena, Italy), Federico Coccolini, Dario Tartaglia and Massimo Chiarugi (General Surgery Unit, University of Pisa, Italy), Roberto Cirocchi (University of Perugia), Paschalis Gavriilidis (Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust. Hammersmith Hospital, London), Juliana Maria Ordonez (University of Valle, Cali Colombia), Gustavo Pereira Fraga (University of Campinas, Brazil), Bruno Monteiro Pereira (Unicamp, Brazil), Goran Augustin (Department of Surgery, University Hospital Centre, Zagreb, Croatia), Alice Gori (University of Bologna, Italy), Stavros Gourgiotis (Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK), John M. Bennett (Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK), Jonathan Morton (Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK), Giosia Di Saverio (General Surgery Unit, Sant’Omero Hospital (TE), Italy), Maurizio Cervellera (Emergency Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy), Marcelo Augusto Fontenelle Ribeiro Jr (Department of Surgery, Universidade Santo Amaro, Sao Paulo, Brazil), Daniel Souza Lima (General Surgery Unit, Sao Carlos Hospital, Dr. José Frota Institute, Fortaleza, CE, Brazil), Carlos Yànez (SALUD, Zaragoza, Spain).
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SDS performed all the surgical procedures; AB, ES assisted in OR the attending surgeon SDS; SDS and GT developed the indications and selection criteria; AB and ES collected and analysed the data; AB wrote the article; MP, VT, MC, AA, GT, RL, SDS edited and revised critically the final article.
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Birindelli, A., Podda, M., Segalini, E. et al. 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 72, 503–512 (2020). https://doi.org/10.1007/s13304-020-00739-0
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DOI: https://doi.org/10.1007/s13304-020-00739-0