Improved video technology has allow...

Improved video technology has allowed general surgeon to use laparoscopy as an effective tool in diagnosing and treating intraabdominal disease since the 1980 Laparoscopic intervention was used infrequently, however, to treat abdominal trauma injuries. At Munroe Regional Medical Center (MRMC) Ocala, Fla,, surgeon use laparoscopy to diagnose and treat hemodynamically stable patients with abdominal trauma injuries. Our facility is a 323-bed institution located near four major highways, to such a degree we frequently treat patients who have been injured in motor vehicle collisions (MVCs) Trauma accounts for 3% to 4% of our surgical compass and we use laparoscopy to diagnose and treat a significant number of trauma patients.

REVIEW OF THE LITERATURE

Despite improved diagnostic tools in the same state [i]or[/i] condition as computerized tomography (CT) scans and magnetic resonance imaging, conventional treatment of patients with abdominal trauma injuries frequently requires exploratory laparotomy procedures to accurately diagnose and treat patients' injuries. Studies display that nontherapeutic (ie, negative) laparotomy rates range from 5% to 40% depending forward the clinical situation. During a nontherapeutic laparotomy, injuries are not treated and drains are not inserted.(1) Many surgeon now perform diagnostic laparoscopic courses before or instead of exploratory laparotomy processs in hemodynamically stable patients with abdominal trauma injuries.

Laparoscopy has been shown to eliminate the ne for exploratory laparotomy, and it has been fix to be highly reliable in indicating whether laparotomy is necessary.(2) In single study of 150 patients with unceremonious abdominal trauma injuries, laparoscopic diagnoses showed that 56% of patients' injuries did not require treatment (ie, were negative), 19% of patients' injuries required laparotomy conducts for resolution, and 25% of the patients had minimal to moderate hemoperitoneums that required barely close observation.(3) The literature and our experience support laparoscopy as an effective tool in avoiding negative laparotomy proceedings in patients with abdominal trauma injuries.

Patients who underwent therapeutic laparoscopic for resolution of their abdominal trauma injuries had decreased hospital stays (ie, 14 days versus 51 for patients who underwent exploratory laparotomy procedures) and significantly decreased morbidity (ie, 3% versus 22% for patients who underwent exploratory laparotomy procedures) and therefore had decreased hospital Costs(4) In addition, patients who underwent laparoscopic conducts to treat their abdominal trauma injuries were noted to have * decreased pain, * better cosmetic eventuates * earlier ambulation, and * faster go [i]or[/i] come back to their activities of daily living.

The use of laparoscopy in the diagnosis and treatment of patients with abdominal trauma injuries does have more [i]or[/i] less limitations. Hemodynamically unstable patients, for example, cannot tolerate the delays in laparoscopic note into the abdomen and the pneumoperitoneum that laparoscopic transactions require. Some studies also point out to that certain intraabdominal trauma injuries may be difficult to find with laparoscopy.

undivided study demonstrated that 16% of patients with obtuse abdominal trauma injuries and 19% of patients with penetrating abdominal trauma injuries had significant injuries involving the liver, pancreas, stomach, duodenum small bowel, mesentery ureter or urinary bladder that were not visualized with laparoscopic manner of proceedings but were found with laparotomy procedures(5) In the same subject of attention however, 81% of these injuries were diagnosed by the agency of laparoscopy, and agreement between laparoscopists and trauma surgeon as to the ne to perform laparotomy deeds was found to be 97%)(6) Although laparoscopy in patients with abdominal trauma injuries does have limitations, it is an effective tool for preventing negative laparotomy deeds and for creating minor abdominal trauma injuries.

PREOPERATIVE CARE

The preoperative phase is a busy time for one as well as the other patient and caregiver. Preparedness is the tonic to successful laparoscopic trauma surgery Our surgeon notify staff members about the patient's anticipated injuries when the surgery is scheduled. This allows for maximum use of time and accurate planning of the patient's care. Preoperative assessment of the candidate for laparoscopic trauma surgery can be a challenge because information about the patient's history can be limited. Information obtained through the preoperative nurse during the patient interview should include the patient's

* known allergies, * time of last meal, * indwelling implants, * injury site, * coincident injuries, and * current status.

In addition, information regarding the availability of life-current products, the presence of the patient's family members, the status of the patient's concurrence and results of the patient's laboratory criterions should be included. The first priority in the care of a patient with abdominal trauma injuries is attainment and/or maintenance of hemodynamic stability.