Cavitary endoscopy in trauma: 2001

Laparoscopy and thoracoscopy have been used in the evaluation of injured patients for over 30 years. Despite this long history, indications for use of these techniques remains controversial. The widespread availability of videoscopic equipment which followed the introduction of laparoscopic cholecystectomy increased interest and utilization of minimally invasive techniques in evaluation of trauma patients. Laparoscopy has been most beneficial in the evaluation of hemodynamically stable victims of stabbings and gunshots. This technique has primarily been used to detect peritoneal penetration in tangential wounds of the abdominal wall and for evaluation of the diaphragm in patients with thoracoabdominal wounds. Laparoscopic evaluation in blunt trauma patients is of unproven utility, but has been used in the assessment of patients with documented solid organ injury and in the evaluation of patients with suspected hollow viscus injury. Small subsets of patients are candidates for therapeutic laparoscopic interventions, i.e., suture repair of diaphragmatic lacerations. Thoracoscopy or videoassisted thoracic surgery (VATS) is useful for evaluation of the diaphragm, early evacuation of clotted hemothorax, and assessment of ongoing bleeding.