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. 2021 Jun;35(6):2667-2670.
doi: 10.1007/s00464-020-07687-1. Epub 2020 Jun 4.

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

Deepika Koganti  1 , Benjamin J Hazen  2 , Christopher J Dente  2   3 , Jonathan Nguyen  4   3 , Rondi B Gelbard  2   3
Affiliations

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

Deepika Koganti et al. Surg Endosc. 2021 Jun.

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.

Keywords: Blunt trauma; Diagnostic laparoscopy; Laparoscopy; Penetrating trauma; Trauma.

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Conflict of interest statement

Dr. Jonathan Nguyen reports personal fees and non-financial support from Z-Medica, Prytime Medical, and Zimmer Biomet, outside the submitted work. Drs. Deepika Koganti, Benjamin Hazen, Christopher Dente, and Rondi Gelbard have no conflicts of interest or financial ties to disclose.

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