Diagnostic and therapeutic laparoscopy for trauma: a technique of safe and systematic exploration

Laparoscopy has a limited role in the evaluation of a stable trauma patient. The main concern addressed in the literature is a significant potential for missed visceral injury and a minimal role for therapeutic application. We present a simple technique for systematic abdominal exploration for a suspected intraabdominal injury in a series of three consecutive trauma patients (two penetrating injuries, one blunt) at a level-one trauma center. Three 5-mm ports and a 30-degree laparoscope were used for exploration. Additional ports for retraction were used as needed for therapeutic procedures. All patients underwent complete exploration of the abdominal cavity. Therapeutic procedures consisted of suturing an intraperitoneal bladder rupture, draining a lacerated tail of the pancreas, and cauterizing an actively bleeding penetrating wound to the left lobe and caudate lobe of the liver. All patients experienced prompt and uncomplicated recovery. There were no missed injuries. The presented technique enables a systematic laparoscopic exploration of the abdomen, which follows the same principles as open exploration. The role of laparoscopy in the treatment of a stable trauma patient is likely to increase as more surgeons acquire advanced laparoscopic skills, and as systematic exploration techniques are used.